Page 99 - 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

which can mimic a MSK dysfunction (Goodman et al., 2018). Detecting warn-
ing signs - red flags requires therapists‘ vigilance and advanced clinical reason-
ing skills. Considering evidence supporting red flags and the patients individ-
ual profile the therapist determines his level of concern and decides on clinical
action. The patient can be treated, treated and referred or only referred (Finu-
cane et al., 2020).

Historically, red flags were used to define serious pathologies, but it is
still not clear which red flags should be considered. There is a lack of evidence
which red flags are informative, especially when used in isolation (Finucane et
al., 2020).
Furthermore, the need for screening also create factors such as viscer-
al pain mechanism, side effects of medication and comorbidities. Even with-
out direct access, screening is necessary if the patient is unresponsive on treat-
ment, the therapist experienced an unexpected outcome or the patient might
not report symptoms or concern because of fear or discomfort (Goodman et 99
al., 2018).
The aim of this study was to investigate the effects and impact of self-ref-
eral options and access to physiotherapy without referal from a doctor on pa-
tients, physiotherapists and healtcare system.

Methods the role of medical screening in physiotherapy

A literature search in the PubMed and CINAHL databases between Novem-
ber 2023 and March 2024 was conducted to identify studies evaluating direct
access services in physiotherapy primary care settings. The review included
open access to full texts of randomized controlled trials and qualitative stud-
ies published since 2018. We searched using the search string of keywords
or their combinations in English language, “direct access”, “physiotherapy”,
“red flags”. To be eligible for inclusion, studies had to evaluate primary care,
and direct access services to physiotherapy for adults with musculoskeletal
conditions in terms of clinical outcomes (pain, functional disability) and/or
socio-economic factors (patient satisfaction, healthcare costs). We excluded
texts in other languages than English, letters, protocols and studies that were
not fully available.
This review was conducted following the Preferred Reporting Items for
Systematic Reviews and Meta-analysis (PRISMA) 2020 statement (Page, et al.,
2021).

Results
The review was done by a physiotherapist who attained recognized education
qualification including medical screening which meets the educational re-
quirements for first contact practitioners.