Page 98 - 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

Keywords: screening, red flags, physiotherapy, physiotherapeutic
diagnosis

Introduction

Musculoskeletal Conditions
Musculoskeletal pain problems including osteoarthritis, low back pain, shoul-
der pain and neck pain in ageing population are leading causes for disability
globally (Murray et al., 2010). This group of diseases is characterized by persis-
tent pain, and limited functional and psycho-social abilities. Musculoskeletal
(MSK) disease is second most common cause for primary care visits and work
absentisem in Slovenia (Ministrstvo za zdravje, 2023). Evidence show that they
often relapse and become long-term conditions (Dunn et al., 2006). As such,
they are a growing challenge for primary care and a huge economic burden of
98 the healthcare system worldwide. In Slovenia, they represent 5 % of all health-
care costs which is 0,4 % of gross domestic product (GDP) between 2016 - 2018
zdravje delovno aktivnih in starejših odraslih | health of working-age and older adults
(Sedlak et al., 2021).
Direct Access
Traditionally patients with MSK conditions are referred by general practition-
ers (GP) to physiotherapists which usually results in a delay in care. Recently,
in some countries a new healthcare pathway to access physiotherapy services
as the first contact was developed. Direct access (DA) to physiotherapy is an or-
ganizational model, where patients have the possibility to self refer, to directly
seek physiotherapist and is available and well accepted in several countries in-
cluding the Netherlands, United Kingdom, Australia, Brazil and most of USA
(Piscitelli et al., 2018). However, there are variations in how direct access ser-
vice is being utilized in practice (National assocciation of primary care, 2015).
The professional workforce delivering first contact in DA healthcare
model are physiotherapists with extended skills who assess and manage pa-
tients with MSK conditions (Ojha et al., 2014). Direct access increases the pro-
fessional responsibility of physiotherapists and requires additional knowledge
(Vignaud et al., 2023). The essential part of the physiotherapeutic assessment
at first contact is to make sure that the patient is an appropriate candidate for
physical therapy (Finucane et al., 2020).
Evidence show that the effects of DA are promising: reduction of work-
load for GP, reduction in costs for the patient and the healthcare system, and
improvement in healthcare indicators e.g. quality of life and disability (Ojha et
al., 2014).

Medical Screening
As an essential part of this process, the therapist should screen for medical
diseases and detect signs and sympthoms of a non-MSK disease or a disease