Page 103 - Petelin, Ana. 2024. Ed. Zdravje delovno aktivnih in starejših odraslih | Health of the Working-Age and Older Adults. Zbornik prispevkov z recenzijo | Proceedings. Koper: University of Primorska Press

However, the existing evidence should be interpreted with caution when
ensuring effective implementation of DA into practice (Igwesi-Chadobe et al.,
2021). The DA model of care tends to cause inequality in health care use, sug-
gesting that it depends on age, gender, ethnicity, and education level of the
patients. White, younger, educated women, from less deprived backgrounds
tend more likely to self-refer (Harvey-Sullivan et al., 2024). Additionally, Ig-
wesi-Chidobe et al. (2021) reports poor public awareness about DA pathway
and the scope of physiotherapy which indicates that there is a need to im-
prove multidisciplinary communication, patient awareness, and public health
literacy.
A systematic review by Lin et al. (2018) identifies eleven recommenda-
tions for best care for MSK disorders from high-quality clinical practice guide-
lines as follows: care should be patient-centered, practitioners should screen
patients for serious pathology and red flags, physical assessment for spinal pain
should include neurological screening test and the patient progress evaluat- 103
ed with validated measures. Furthermore, they recommend patient education,
addressing physical activity in patient management, discouraging radiological
imaging unless serious diseases are detected and manual therapy in combina-
tion with other approaches should be therapists` first choice strategy to man-
age patients with MSK disorders.
Direct access model is safe (Gallotti et al., 2023) and shows rare risk for the role of medical screening in physiotherapy
adverse effects in the whole physiotherapy practice not just related to MSK con-
ditions (Piscitelli et al., 2018).
Regardless of all the benefits of DA a lot of countries in Europe including
Slovenia still do not adopt this model. Nevertheless, the physiotherapists com-
munity in Slovenia is increasing its role and competence and offer postgradu-
ate program. In addition, some physiotherapists have already achieved interna-
tional musculoskeletal certification acquiring advanced knowledge and skills
following the International Federation of Orthopedic Manipulative Physical
Therapy standards. Existing evidence from a cross-sectional study by Souter et
al. (2019) suggests that post-professional specialization is a mainstay for devel-
oping advanced clinical, decision making, and reasoning skills level.
According to our knowledge, this is the first study in Slovenia that re-
ports the importance of screening for red flags and serious diseases in physio-
therapy management of MSK disorders and furthermore, suggests how physi-
otherapists can contribute to health care efficiency and utilization.
This review has some limitations. First, the research was performed on-
ly in two databases, and some relevant article may not have been included.
Second, most of the included studies were conducted in countries (e.g. United
Kingdom, USA) where DA is already adopted and screening process is an es-
sential part of each physiotherapy assessment. However, their health care sys-
tems were initially facing same problems as in Slovenia.