Digital screening on
red flags by means of the
internet
Author:
Ton Vogelaar MSc.
Co-author: Freek Weijers MSc.
Digital screening
Two screening instruments;
Screening test
2. Screening form for practices
1.
Both with the same red flag questionnaires
Digital screening
Developed by two MSc.MT’s;
Both teacher during the obligatory course
concerning the direct access physiotherapy in
the Netherlands;
Website:
www.fysio-uniek.nl
Background
Direct access physiotherapy in the Netherlands
on January 1st. 2006;
All registered physiotherapists had to follow a
course;
Screening on at-risk factors, the so-called red
flags;
Lists with red flags were distributed by complaint
region.
Background
The policy of the Dutch board for physiotherapy
(KNGF) was that a score of one red flag meant
that the patient had to be referred to the general
practitioner, but;
During the course physiotherapists were also
trained to weigh the red flags.
Design
Digital red flag screening questionnaires were
designed by region (11);
Those were published on the website
The patient themselves did choose region and
filled in the red flag questionnaire;
Design
The red flags were weighed;
Minimum weight was 1 point, maximum 3 points;
Patients were given the advice to consult the
general practitioner at scores of 3 points or
more.
Red flags
Red Flag Questions
weighing
Has there been an accident/trauma?
1
Have you had a inexplicable fever for more than a week? 3
Have you lost more than 5 kilograms without
apparent reason in the last month?
2
Have you ever been diagnosed with a form of cancer?
1
Are you, in general, feeling not well?
2
Are you woken up by pain during the night?
1
Have you been suffering (ever since you have had these
complaints) from loss of senses (e.g. a sense of deafness),
diminished strength or loss of coordination?
3
Objectives
What percentage of patients, purely based on
these digital red flag questionnaires, would be
recommended to consult the general
practitioner?
= Overall percentage who scored 3 points or
more;
Percentage 3 or more points by each region
Methods
The whole Dutch population could participate on
the screening test;
Moreover patients were asked to fill in the
anamnesis questionnaire before their first
appointment;
5 physiotherapy practices in the south of the
Netherlands are using this screening form.
Overall results
In the first 10 months of 2007 digital screening
on red flags was used by 1148 Dutch patients;
Till the sixth of May 2008 the red flag lists were
used 1525 times.
Overall results
In the first 10 months 723 of the 1148 patients
scored 3 or more points.
In percentage this is 63%
Till the sixth of May 2008, 940 of the 1525
patients scored 3 or more points.
In percentage this is 62%
Results lower back and neck region
492 patients filled in the questionnaire
concerning the lower back region (32,3%)
Of these 492 patients 73% (n=357) scored 3
points or more
281 patients filled in the questionnaire
concerning neck region (18,4%)
Of these 281 patients 63% (n=178) scored 3
points or more
Results table
Discussion
Head and lower back scored the highest
percentage, these regions do also have more
red flag questions;
Low percentage for thoracic spine region and
lower extremity;
Conclusions
A high percentage (average of 62%) score one
red flag or more on these digital questionnaires;
The upper extremities scored a striking higher
percentage (average of 63%) then the lower
extremities (average of 42%)
Clinical consequence?
Recommendation
Quantity en quality investigation of these
digital red flag questionnaires is necessary to
validate this system and get more information
of the clinical relevancy.
Thanks for your attention
English version screening test and
screening form coming soon on:
www.fysio-uniek.nl
[email protected]