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References
ARMA 2004 Standards of care for people with low back
pain. Online. Available: www.arma.uk.net
Asher R 1954 Straight and crooked thinking. BMJ
September: 460–462
CSAG 1994 Report of a Clinical Standards Advisory Group
on Back Pain. HMSO, London
Prodigy 2005 Low back pain. Online. Available: www.
prodigy.nhs.uk/guidance
CONCLUSION
199
Ancient Greece,
rehabilitation in, 7
Antibiotics, tuberculosis, 39
Appearance
mass, 174
spinal deformity, 174
unwell, looking, 172–173
Arthritis and
Musculoskeletal
Alliance (ARMA), 194
Australian Physiotherapy
Association, 133
Babinkski, Joseph François
Felix, 183
Back pain, 17–18
activity, related to, 92
cancer, 92, 97, 99
Linton and Halden Initial
Back Pain
Questionnaire, 56
low, 20, 97, 99
201
Abdominal lymphoma, 101
Abdominal pain, 137–138
Africa, AIDS-related deaths,
40
Age
above 55, as Red Flag, 93
breast cancer, 95
cancer type and age
group, 93–94
index of suspicion, 96
lung cancer, 94, 95
myeloma, 94, 95
prostate cancer, 94
subjective examination,
91–96
Agency for Health Care
Policy and Research
(AHCPR) 1994
clinical guidelines, 19–20
AIDS see HIV/AIDS
American Cancer Society, 26
Analgesia, 136, 138
Index
Please note that page references to any non-textual information
in boxes are in italic print
mechanical, non-specific
diagnosis, 92
Back Pain Revolution
(G Waddle), 52
Basal metabolic rate,
increase, 118
Bayes’ theorem, clinical
reasoning, 64, 66
Bayes, Thomas, 64
Bence Jones proteins, 126
Bias, clinical reasoning, 70–71
Bichat, Marie François
Xavier, 27
Bickels, J, 136, 174
Biopsychosocial models
health, 71
illness, and pain
presentation, 52–53,
55–56
Black Flags, occupational
factors, 52
Blue Flags, social and
economic factors, 52
Boissonnault, W G, 22, 23,
117
Bone cancer, 101
Bone mass, post-menopausal
loss, 106
Bone tumours, 31
Bowel habits, altered,
137–138
absence of medication,
138
Bowel/bladder disturbances,
178, 179
Brain tumour, and headache,
21, 22, 141–142
INDEX
202
Breast cancer, 30–31
age, 94, 95
BRCA2 mutation, 100
female gender, as risk
factor, 99–100
hypercalcaemia, 137–138
metastatic disease, 77, 99
and smoking, 66
British Association for
Parenteral and Enteral
Nutrition, 118
Brucellosis, Red Flag list,
35–36
Butler, D S, 2, 51
Cachexia (weight loss),
cancer, 68–69, 118, 119
Cancer
and age see under Age
asymptomatic, early
detection, 30
and back pain, 92, 97, 99
bone, 101
breast see Breast cancer
carcinogens, 26–27, 109
caudal/cephalad site, 31
definition, 27
early stages, patient
behaviour, 75–76
electrolyte imbalance, 102
family history, 96–97
historical evidence, 26
Hodgkin’s disease, 100,
101
intraspinal tumours, 91,
98
leukaemia, 68, 125
life expectancy, 27
lung see Lung cancer
lymphoma, 100, 101
medical history, 68,
96–102
myeloma see Myeloma
non-Hodgkin’s
lymphoma, 100, 101
presenting factors,
combination, 68
previous, history-taking,
68
prostate, 94
Red Flag list, 26–33, 28,
29, 30
risk factors, 28
scrotum, 27
spread of see Metastases
stages of development, 29
timescale of type, 33
warning signs, 97
weight loss, 68–69, 118,
119
see also Tumours
Carcinogens, 26–27, 109
Cardiovascular system, signs
and symptoms, 22
Carpal tunnel syndrome,
bilateral, 184–185
Cauda equina syndrome
current episode
questions, 122–125
incontinence, 123
sacral nerve roots, injury,
122–123
saddle disturbance, 179
symptoms, 122
INDEX
203
CD4+ T cells, HIV/AIDS, 40,
103
Cephalad vertebral
segments,
neurological deficit,
177
Cervical spondylosis
cervical myelopathy, 184
neurological deficit, 178
Chalmers, A F, 64–65
Chartered Society of
Physiotherapy (CSP)
establishment, 8
extended scope
practitioners (ESPs),
establishment of
clinical interest group,
6
Clinical decision making,
index of suspicion, 3
Clinical guidelines, 14–20
Agency for Health Care
Policy and Research
(AHCPR) 1994, 19–
20
Clinical Standards
Advisory Group
(CSAG) 1994 report,
16–18
European Union, 20
New Zealand Acute Low
Back Pain Guide,
20
Royal College of General
Practitioners, 20
Quebec Task Force Report
1987, 14–16, 20
Clinical reasoning, 49–87
as analytic process, 2
Bayes’ theorem, 64, 66
bias, 70–71
categories, 60–61, 72, 73
definition, 58
diagnostic reasoning
model, 61–62, 66–67
positive paradigm, 71
theorem use, 66
error, 70
ethical, 61, 72, 73
health behaviour, 73–77
history-taking, 67–68
horse/zebra illustration,
63–64, 65
hypothetico-deductive
reasoning model, 61,
62
metacognition, 60
narrative categories, 60
non-verbal cues, 61–62
osteoporosis, 69
pain and psychosocial
flags, 51–57
pattern recognition, 61
positivist paradigm, 61
pragmatic, 61, 72, 73
scientific categories, 60
spinal infection, 70
thought processes,
clinician’s reflections
on own, 58, 60
three-dimensional
thinking, 58, 59
weighted Red Flag list,
80, 81–82
INDEX
204
Clinical Standards Advisory
Group (CSAG)
and AHCPR guidelines,
19
clinical guidelines, 16–18,
194
biopsychosocial
approach, 55–56
on diagnostic triage, 17
drug addiction, Red Flag
list, 34
and Red Herrings, 20–21
Coman, W, 131
Communication skills, 197
Conditional probabilities, 3,
66, 68
Conner, M, 74
Crouch, M, 76
CSAG see Clinical Standards
Advisory Group
(CSAG)
CSP see Chartered Society of
Physiotherapy (CSP)
Current episode questions
cauda equina syndrome,
122–125
pins and needles,
bilateral, 133
previous failed treatment,
133–135
systemic illness, 125–127
trauma, 127–130, 128,
129
vertebrobasilar
insufficiency (VBI),
131–133
weight loss, 117–121
Cyriax, James
on pathology,
development of
indicators, 8–9
on physical examination,
173
on physiotherapy, 7
Red Flags of, 10
on tuberculosis, 38–39,
103
Danger signs, hierarchy, 80
Deyo, R A
on cancer, 68–69, 75
on history-taking, 67–68
on subjective
examination, 90, 98
on tuberculosis, 103
Diagnostic reasoning model,
61–62, 66–67
positive paradigm, 71
theorem use, 66
Diagnostic tests, as funding
priority, 67
Dillin, W H, 92, 93
Distraction test, cervical
instability, 182
Dizziness, vertebrobasilar
insufficiency, 131
Downing, A M, 70
Doyle, Sir Arthur Conan, 63
Drug addiction, Red Flag list,
34
Durie, B G M, 66
Edeling, J, 140
Edwards, I, 61, 71
INDEX
205
Edwin Smith papyrus, 26
Electrolyte imbalance, 102
physical examination, 173
Erythrocyte sedimentation
rate (ESR), 126–127,
128
ESPs see Extended scope
practitioners (ESPs)
Ethical reasoning, 61, 72, 73
Extended scope practitioners
(ESPs)
clinical interest group,
establishment by CSP,
6
role, 6–7
Family history, cancer, 96–97
Female gender, as cancer risk
factor, 99–100
Finland, breast cancer, 95
Frymoyer, J W, 68, 174, 175
Gait, disturbed, 184–185
Gifford, L, 2, 51, 183
Goodman, C C, 178
Grieve, GP
on brucellosis, 36
on cancer, 31, 32–33
on cauda equina
syndrome, 124
on neurological deficit,
177
on pain diagnosis, 52
on pathology, 2, 23
on Red Herrings and
masquerades, 20–21,
22
on thoracic dysfunction,
21
Hack, L M, 71
Hawkes, C, 184
Head, Henry, 175
Headache, 139–142
and brain tumour, 21, 22,
141–142
Health behaviour, clinical
reasoning, 73–77, 74
Health beliefs, 75
Hip fractures, osteoporosis,
106
Hippocrates, 7, 26
History-taking see Medical
history
HIV/AIDS
in Africa, 40
CD4+ T cells, 40, 103
diagnosis, 40–41, 104–105
drug use, injections,
105–106
medical history, 103–105
Red Flag list, 40–42
transmission, 104
tuberculosis, 38, 39,
41–42
in United States, 40
Hodgkin’s disease, 100, 101
Horse/zebra illustration,
clinical reasoning,
63–64, 65
Human immunodeficiency
virus see HIV/AIDS
Hunter, D G, 70
Hurley, D A, 56
INDEX
206
Hypercalcaemia
breast/lung cancer,
137–138
physical examination, 173
systemic illness, 126
Hypogammaglobulinaemia,
systemic illness, 126
Hypothetico-deductive
reasoning model, 61,
62
IASP (International
Association for the
Study of Pain), 50–51
Illness, biopsychosocial
model, 52–53, 55–56
Immunoglobulin, and
multiple myeloma,
100
Incontinence, cauda equina
syndrome, 123
Index of suspicion
age, 96
clinical decision making,
3
lung cancer, 94
myeloma, 94
neurological deficit,
176–177
Red Flag items, 2–3
weight loss, 120
Infections
brucellosis, 35–36
fever, 70
HIV/AIDS see HIV/AIDS
pyogenic, 34–35
spinal, 70
Staphylococcus, 35
tuberculosis see
Tuberculosis (TB)
International Association for
the Study of Pain
(IASP), 50–51
International Myeloma
Foundation, 65, 66
Intraspinal tumours, 91
Investigations, examples, 196
Ipsilateral Horner’s
syndrome, whiplash,
130
Ischaemia, and
vertebrobasilar
insufficiency, 131
Jarvik, J G, 75, 98
Jones, M A, 58, 60, 61, 62,
63–64, 65
Kaposi’s sarcoma, and AIDS,
105
King, H, 92
Koch, Robert, 37
Leong, J C Y, 35
Leukaemia, 68
as systemic illness, 125
Leventhal, E, 76
Lhermitte’s sign, and
multiple sclerosis, 177,
178
Life expectancy, cancer, 27
Lifestyle questions, 108–110
Likelihood ratios, calculation,
66–67
INDEX
207
Linton and Halden Initial
Back Pain
Questionnaire, 56
Luk, K D K, 35
Lung cancer
age, 94, 95
deaths from, 29
hypercalcaemia, 137–138
index of suspicion, 94
smoking, 108–109
Lupus erythematosus,
malignant lymphoma
masquerading as, 101
Lymphadenopathy, in non-
Hodgkin’s disease,
101
Lymphoma, 100, 101
Macfarlane, R, 124
McKenzie, Robin A, 11, 67,
91, 134, 135
McMillan Report, on
physiotherapy
profession (1973), 8
Magarey, M E, 131, 180
Maitland, Geoffrey, 11, 12
Malignant disease see Cancer;
Tumours
Malnutrition, and cachexia
(weight loss), 69, 119
Malnutrition and Universal
Screening Tool
(MUST), weight loss,
119–120
Maltzman, J D, 102
Massage scandal, London
(1894), 7–8
May, S, 67, 134
Mechanical disc disorders,
thoracic pain, 137
Mechanical dysfunction,
night pain, 139
Medical history
cancer, 96–102
previous, 68
clinical reasoning, 67–68
current episode
questions, 117–135
HIV/AIDS, 103–105
drug use, 105–106
oesophageal candidiasis,
105
osteoporosis, 106, 107
subjective markers,
67–68
tuberculosis, 102–103
Mennell, James, 8
Red Flags of, 10
Science and Art of Joint
Manipulation, 9
Metacognition, 60
Metastases
breast cancer, 77, 99
and cure, unlikelihood of,
75
spine, 31, 32
spread mechanisms, 30,
32
thoracic pain, 137
Migraine, 140
Moore, A P, 182
Movement, marked partial
articular restriction,
178
INDEX
208
Multiple sclerosis, 184
Lhermitte’s sign, 177,
178
Murphy, E A, 70
Mycobacterium tuberculosis,
37, 38
Myeloma
age, 94, 95
index of suspicion, 94
multiple, incidence of,
100
neutropenia, 126
physical examination, 173
predisposing factors, 65,
66
systemic illness, 125–126
weight loss, 69
Myelopathy
carpal tunnel syndrome,
184–185
cervical spondylosis, 184
Narrative reasoning, 71, 72
Neck pain, whiplash, 130
Neoplastic disease see Cancer
Neurological deficit
bizarre, 175–178
cephalad vertebral
segments, 177
cervical spondylosis, 178
gross multiple, 175–176
index of suspicion,
176–177
tumours, spinal cord, 178
Neutropenia, myeloma, 126
New Zealand Acute Low
Back Pain Guide, 20
NHS Modernisation Agency,
principles advocated
by, 198
Night pain, 138–139
Non-Hodgkin’s lymphoma,
100, 101
Non-steroidal anti-
inflammatories, 136
Norman, P, 74
Numbness, cauda equina
syndrome, 122
Nutrition Risk Score, weight
loss, 119
Objective examination
gait, disturbed, 184–185
movement, marked
partial articular
restriction, 178
neurological deficit,
bizarre, 175–178
physical appearance see
Appearance
positive extensor plantar
response, 183–184
S4 sensation, altered,
178–179
spasm, 179
sphincter tone, loss of,
178–179
supine position, inability
to maintain, 174–175
upper cervical instability
tests, 181–182
vertebral artery testing,
179–181
warning signs, 12–13
INDEX
209
see also Subjective
examination
Ockham, William of, 63
Oesophageal candidiasis,
medical history, 105
Ombregt, L, 179
Opioids, 138
Orange Flags, psychiatric
factors, 52
Osteoblastoma, spinal
deformity, 174
Osteoid osteoma, spinal
deformity, 174
Osteomyelitis, spinal regions
affected by, 34
Osteoporosis
clinical reasoning, 69
medical history, 106, 107
presenting factors,
combination, 69
Paget, Rosalind, 8
Pain
abdominal, 137–138
back see Back pain
changed bowel habits,
137–138
constant progressive,
135–136
definition, 50–51
dimensions, interacting,
51
headache, 139–141
mnemonic for physicians,
56
neck, 130
night, 138–139
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