1. Digital screening on red flags by means of the internet Author: Ton Vogelaar MSc. Co-author: Freek Weijers MSc.

2. Digital screening Two screening instruments; 1. Screening test 2. Screening form for practices Both with the same red flag questionnaires

3. Digital screening Developed by two MSc.MT’s; Both teacher during the obligatory course concerning the direct access physiotherapy in the Netherlands; Website: www.fysio-uniek.nl www.fysio-uniek.nl

4. Background Direct access physiotherapy in the Netherlands on January 1st. 2006; All registered physiotherapists had to follow a course; Screening on at-risk factors, the so-called red flags; Lists with red flags were distributed by complaint region.

5. Background The policy of the Dutch board for physiotherapy (KNGF) was that a score of one red flag meant that the patient had to be referred to the general practitioner, but; During the course physiotherapists were also trained to weigh the red flags.

6. Design Digital screening questionnaires were designed by region (11); Digital red flag screening questionnaires were designed by region (11); Those were published on the website The patient themselves did choose region and filled in the red flag questionnaire;

7. Design The red flags were weighed; Minimum weight was 1 point, maximum 3 points; Patients were given the advice to consult the general practitioner at scores of 3 points or more.

8. Red flags

9. Has there been an accident/trauma? 1 Have you had a inexplicable fever for more than a week? 3 Have you lost more than 5 kilograms without apparent reason in the last month? 2 Have you ever been diagnosed with a form of cancer? 1 Are you, in general, feeling not well? 2 Are you woken up by pain during the night? 1 Have you been suffering (ever since you have had these complaints) from loss of senses (e.g. a sense of deafness), diminished strength or loss of coordination? 3 Red Flag Questions weighing Red Flag Questions weighing

10. Objectives What percentage of patients, purely based on these digital red flag questionnaires, would be recommended to consult the general practitioner? = Overall percentage who scored 3 points or more; Percentage 3 or more points by each region

11. Methods The whole Dutch population could participate on the screening test; Moreover patients were asked to fill in the anamnesis questionnaire before their first appointment; 5 physiotherapy practices in the south of the Netherlands are using this screening form.

12. Overall results In the first 10 months of 2007 digital screening on red flags was used by 1148 Dutch patients; Till the sixth of May 2008 the red flag lists were used 1525 times.

13. Overall results In the first 10 months 723 of the 1148 patients scored 3 or more points. In percentage this is 63% Till the sixth of May 2008, 940 of the 1525 patients scored 3 or more points. In percentage this is 62% In percentage this is 62%

14. Results lower back and neck region 492 patients filled in the questionnaire concerning the lower back region (32,3%) Of these 492 patients 73% (n=357) scored 3 points or more 281 patients filled in the questionnaire concerning neck region (18,4%) Of these 281 patients 63% (n=178) scored 3 points or more

15. Results table

16. Discussion Head and lower back scored the highest percentage, these regions do also have more red flag questions; Low percentage for thoracic spine region and lower extremity;

17. Conclusions A high percentage (average of 62%) score one red flag or more on these digital questionnaires; The upper extremities scored a striking higher percentage (average of 63%) then the lower extremities (average of 42%) Clinical consequence?

18. Recommendation Quantity en quality investigation of these digital red flag questionnaires is necessary to validate this system and get more information of the clinical relevancy.

19. Thanks for your attention English version screening test and screening form coming soon on: www.fysio-uniek.nl www.fysio-uniek.nlwww.fysio-uniek.nl ton@fysio-uniek.nl ton@fysio-uniek.nl