Table 12: Psychological Screening Questions Have you…?
Table 14: Hematology/Lymphatic Screening Questions Do you have…?
a. Been troubled by feelings of depression/hopelessness. b. Had little interest or pleasure in doing things that were enjoyable previously. General health questions Positive answers suggest that the clinician should consider screening the psychological system. Do you have…? Unexplained weight loss/gain, fatigue, paresthesia or unexplained weakness, change in cognition (confusion, irritability, disorientation, anxiety), sleep disturbance, change in emotional status. Note . Adapted from Differential Diagnosis in Physical Therapy (6th ed.), by C. C. Goodman, J. Heich, and R. T. Lazaro, 2018, Philadelphia, PA: W. B. Saunders; Screening for Symptoms of Depression by Physical Therapists Managing Low Back Pain, by S. Haggman, C. G. Maher, and M. Refshauge, 2004, Physical Therapy, 84 (12), pp. 1157- 1166. Table 13: Integumentary Screening Questions Do you have…? a. Recent itching, new rashes, lumps, moles, or other skin changes. b. An increase in hair growth/loss or breakage. c. Change in the appearance of nails/nailbeds. General health questions Positive answers suggest that the clinician should consider screening the integumentary system. Do you have…? Fatigue, paresthesia or unexplained weakness, confusion, disorientation, change in emotional status, a recent change in your medications. Note . Adapted from Differential Diagnosis in Physical Therapy (6th ed.), by C. C. Goodman, J. Heich, and R. T. Lazaro, 2018, Philadelphia, PA: W. B. Saunders. Identification of patients at risk The incidence of cancer as a cause of low back pain is considered to be less than 1% (Deyo & Diehl, 1988). Although cancer is an infrequent cause of low back pain, the presence of cancer has a significant impact on the morbidity and mortality of the individual and on any plan of intervention. In addition, early detection of cancer generally leads to earlier medical intervention, resulting in improved outcomes for the individual. Cancer that forms solid tumors without metastasis does not frequently produce signs and symptoms that send a patient to see a therapist. As a result, depending on the practice setting, a therapist is more likely to see patients whose cancer has metastasized than a patient with signs or symptoms related solely to the original, primary, solid cancer (Goodman et al., 2018). Screening for cancer is an attempt to identify elements in the medical history and risk factors, as well as signs and symptoms that constitute a cluster of findings associated with an increased risk of cancer. Henschke and colleagues (2009) reported that even though the overall incidence of serious pathology as a cause of low back pain was low (0.9%), more than 80% of patients reported a positive response to one or more red flag questions. As a result, a positive response to any red flag question must be viewed within the context of the entire patient to have validity.
a. Changes in nails, nailbeds, or skin color. b. Abnormal bleeding and/or bruising. c. Melena (dark, tarry stool). d. Confusion/irritability/headache. e. Rapid pulse/palpitations.
f. Generalized edema or ascites. g. Swollen, tender lymph nodes.
General health questions Positive answers suggest that the clinician should consider screening the hematology/lymphatic systems. Do you have…? A recent change in body weight, fatigue, dyspnea, and/or weakness. Note . Adapted from Differential Diagnosis in Physical Therapy (6th ed.), by C. C. Goodman, J. Heich, and R. T. Lazaro, 2018, Philadelphia, PA: W. B. Saunders.
SCREENING PATIENTS FOR PROBLEMS RELATED TO CANCER
Deyo and Diehl (1988) showed that cancer can be ruled out as an underlying cause of low back pain with 100% sensitivity if the patient: a. Is younger than age 50.
b. Has no unexplained weight loss. c. Has a negative history for cancer. d. Is responding favorably to conservative therapy.
In addition, Deyo and Diehl (1988) reported that even if there is a positive red flag finding, the likelihood of cancer can still be ruled out with 100% sensitivity if the patient has negative radiographs of the spine and a normal erythrocyte sedimentation rate (an inflammatory marker). On the other hand, a patient over the age of 50 who has unexplained weight loss and failed conservative therapy has an elevated risk of cancer and that risk is increased further if the patient has a history of cancer (Deyo and Diehl, 1988). Obtaining a family medical history is important because some cancers follow a familial pattern. However, only about 5% of all breast, ovarian, and colon cancers are attributed to heredity (Goodman et al., 2018). The risk of hereditary cancer in an individual is elevated if there is: a. Any form of cancer in two or more immediate biological family members, or b. Cancer before the age of 50 in an immediate family member (Goodman et al., 2018).
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