Guideline adherent screening and referral: do third year Doctor of Physical Therapy students identify red and yellow flags within descriptive patient cases? a United States based survey study

ABSTRACT

Introduction

The need for early detection and appropriate management of flags in physical therapy has been established. The lack of early detection has been shown to lead to poor outcomes such as serious pathology, increased disability, prolonged symptoms, and increased healthcare utilization.

Objective

The main purpose of this survey study was to assess third-year Doctor of Physical Therapy (DPT) students’ adherence to clinical practice guidelines specifically in the identification and management of red and yellow flags through a case-based approach.

Methods

A survey including three different flag case scenarios was sent to DPT students in 15 geographically diverse physical therapy programs. Previously published case scenarios measuring adherence to practice guidelines were used. Correlational analyses were performed to link student demographic details and guideline adherent management.

Results

The survey was completed by 64 students. Guideline adherent management was greater for red flags (85%) than yellow flag cases (25% and 42%). No significant relationship was noted between the student details and guideline adherent management.

Conclusion

DPT students may need additional educational content related to yellow flag screening. Educators may consider utilizing published red and yellow flag cases to guide decision-making and highlight best screening practices.

KEYWORDS:

• Physical therapy students
• red flag
• yellow flag
• low back pain management
• clinical practice guidelines

Acknowledgments

Jennifer Pearcy PT, DPT

Matthew Randolph PT, DPT

Samantha Dunlay PT, DPT

Sarah Bradley PT, DPT

Adam Stevens PT, DPT

Adam Church PT, DPT

Kelvin Smith PT, DPT

Madison Burzlaff PT,

DPT Kyle Hershberger PT, DPT

Grant Disney PT, DPT

Justin Yakel PT, DPT

Matthew Stanton PT, DPT

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Michael Bourassa

Dr. Michael Bourassa is the Program Director for the East Tennessee State University Residency and Fellowship Programs and an Associate Professor within the ETSU DPT program. He is board certified in Orthopaedic physical therapy and is a fellow in the American Academy of Orthopaedic Manual Physical Therapists. His research interests include Integration of evidence-based practice and clinical decision-making in patient care, Psychomotor skill development in physical therapy education and the Role of expectations within the practice of physical therapy

William H. Kolb

Dr. William “Wil” Kolb is an associate professor for the Radford University Carilion DPT program teaching in the musculoskeletal and professional development tracts. He has more than twenty-five years of practice including specializing in patients with joint replacement and complex pain. Dr. Kolb serves as president of the Academic and Clinical Faculty Special Interest Group for the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). His research interests include Knowledge Translation for pain education and for best methods of teaching psychomotor skills. He has received grant funding for the development of pain education assessments and the implementation of clinical practice guidelines for patients with low back pain. Dr. Kolb has presented nationally for APTA combined sections meeting and at AAOMPT.

Dustin Barrett

Dustin Barrett graduated from East Tennessee State's Doctor of Physical Therapy program in 2007. He is a Board Certified Orthopaedic Clinical Specialist and a Fellow of the American Academy of Orthopaedic Manual Physical Therapists. He currently works for Emory and Henry College's School of Health Science as a clinical assistant professor.

Craig Wassinger

Craig Wassinger is an Associate Professor and the Director of Research and Faculty Development in the Doctor of Physical Therapy Program at Tufts University (Boston). Has been a physical therapist since 2001. Craig has over 100 peer-reviewed publications and presentations and has held leadership positions in the APTA Pain Special Interest Group and the American Society of Shoulder and Elbow Therapists. His research interests include shoulder injury and rehabilitation, pain science, and educational technology.