Telehealth and Physical Therapy Clinical Decision Making in a Patient with a Falcine Meningioma
Keywords:Medical screening, Physical therapy, Telehealth
Telehealth utilizes information technologies and communication networks to deliver healthcare and education with lower costs and improved access, quality, and efficiency of healthcare services. This report describes the application of telehealth for medical screening, clinical decision making, and medical referral in a physical therapy practice. The patient described was a 50-year old man who contacted his physical therapist via telephone for a chief complaint of worsening left sided numbness and tingling that began insidiously 2 days prior. Further questioning revealed that the patient also complained of left ankle weakness, and slight unsteadiness with walking. He had not been feeling well and had been experiencing increasing bouts of unexplained fatigue over the previous two months that were now interfering with his work and recreational activities. The patient was evaluated by his physician the next day. Magnetic resonance imaging of the brain revealed a large (4 cm) falcine meningioma in the right parietal region. The patient was immediately referred to a neurosurgeon and underwent a craniotomy and tumor resection ten days later and subsequent gamma knife radiosurgery of the residual tumor bed two months after craniotomy and tumor resection. Follow-up imaging one year later revealed no evidence of recurrence or residual tumor. This patient case underscores the importance of recognizing signs and symptoms of serious disease, and how referral following telehealth via telephone can inform diagnosis.
Abry, E., Thomassen, I. Ø., Salvesen, Ø. O., & Torp, S. H. (2010). The significance of Ki-67/MIB-1 labeling index in human meningiomas: A literature study. Pathology - Research and Practice, 206(12), 810–815. https://doi.org/10.1016/j.prp.2010.09.002
American Physical Therapy Association. Practice and patient care. Telehealth. Accessed September 4, 2019. https://www.apta.org/Telehealth/.
Association of American Medical Colleges. The complexities of physician supply and demand: Projections from 2017-2032. https://www.aamc.org/system/files/c/2/31-2019_update_-the_complexities_of_physician_supply_and_demand_-projections_from_2017-2032.pdf
Baldi, I., Engelhardt, J., Bonnet, C., Bauchet, L., Berteaud, E., Grüber, A., & Loiseau, H. (2018). Epidemiology of meningiomas. Neurochirurgie, 64(1), 5–14. https://doi.org/10.1016/j.neuchi.2014.05.006
Basu, S., Berkowitz, S. A., Phillips, R. L., Bitton, A., Landon, B. E., & Phillips, R. S. (2019). Association of primary care physician supply with population mortality in the United States, 2005-2015. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2018.7624
Berkowitz, A.L. (2017) Numbness: A Localization-based approach. In S. C. McKean, J. J. Ross, D. D Dressler, & D. B. Scheurer (Eds.). Principles and Practice of Hospital Medicine (2nd ed.). McGraw-Hill. http://accessmedicine.mhmedical.com/content.aspx?bookid=1872§ionid=146977205.
Bird, S., Thompson, C., & Williams, K. E. (2016). Primary contact physiotherapy services reduce waiting and treatment times for patients presenting with musculoskeletal conditions in Australian emergency departments: An observational study. Journal of Physiotherapy, 62(4), 209–214. https://doi.org/10.1016/j.jphys.2016.08.005
Boissonnault, W.G. & Ross, M.D. (2012). Physical therapists referring patients to physicians: A review of case reports and series. Journal of Orthopaedic Sports Physical Therapy, 42(5), 446-454. https://doi.org/10.2519/jospt.2012.3890
De Gruchy, A., Granger, C., & Gorelik, A. (2015). Physical therapists as primary practitioners in the emergency department: Six-month prospective practice analysis. Physical Therapy, 95(9), 1207–1216. https://doi.org/10.2522/ptj.20130552
Derlet, R. W. (2002). Overcrowding in emergency departments: Increased demand and decreased capacity. Annals of Emergency Medicine, 39(4), 430–432. https://doi.org/10.1067/mem.2002.122707
Di Somma, S., Paladino, L., Vaughan, L., Lalle, I., Magrini, L., & Magnanti, M. (2014). Overcrowding in emergency department: An international issue. Internal and Emergency Medicine, 10(2), 171–175. https://doi.org/10.1007/s11739-014-1154-8
Dumitru, D., Amato, A., & Zwarts, M. (2002) Electrodiagnostic medicine (2nd ed.). Hanley & Belfus.
Grona, S.L., Bath,B., Busch, A., Rotter, T., Trask, C., & Harrison, E. (2018) Use of videoconferencing for physical therapy in people with musculoskeletal conditions: A systematic review. Journal of Telemedicine &Telecare, 24(5), 341- 355. https://doi.org/10.1177/1357633X17700781
Lee, A.C., & Harada, N. (2012) Telehealth as a means of health care delivery for physical therapist practice. Physical Therapy. 92(3), 463-468. https://doi.org/10.2522/ptj.20110100
Lee, A. C., Davenport, T. E., & Randall, K. (2018). Telehealth physical therapy in musculoskeletal practice. Journal of Orthopaedic Sports Physical Therapy, 48(10), 736–739. https://doi.org/10.2519/jospt.2018.0613
Li, J., Liang, R., Song, C., Xiang, Y., & Liu, Y. (2019). Prognostic value of Ki-67/MIB-1 expression in meningioma patients: A meta-analysis. Critical Reviews in Eukaryotic Gene Expression, 29(2), 141–150. https://doi.org/10.1615/CritRevEukaryotGeneExpr.2019025430
Marta, G. N., Correa, S. F. M., & Teixeira, M. J. (2011). Meningioma: Review of the literature with emphasis on the approach to radiotherapy. Expert Review of Anticancer Therapy, 11(11), 1749–1758. https://doi.org/10.1586/era.11.162
Moore, J. H., Goss, D. L., Baxter, R. E., DeBerardino, T. M., Mansfield, L. T., Fellows, D. W., & Taylor, D. C. (2005). Clinical diagnostic accuracy and magnetic resonance imaging of patients referred by physical therapists, orthopaedic surgeons, and nonorthopaedic providers. Journal of Orthopaedic & Sports Physical Therapy, 35(2), 67–71. https://doi.org/10.2519/jospt.2005.35.2.67
Mukand, J. A., Blackinton, D. D., Crincoli, M. G., Lee, J. J., & Santos, B. B. (2001). Incidence of neurologic deficits and rehabilitation of patients with brain tumors. American Journal of Physical Medicine & Rehabilitation, 80(5), 346–350. https://doi.org/10.1097/00002060-200105000-00005
Nelson, M.J., Crossley, K.M., Bourke, M.G., & Russell, T.G. (2017) Telerehabilitation feasibility in total joint replacement. International Journal of Telerehabilitation, 9(2), 31-38. https://doi.org/10.5195/ijt.2017.6235
Prentice, J. C., & Pizer, S. D. (2007). Delayed access to health care and mortality. Health Services Research, 42(2), 644–662. https://doi.org/10.1111/j.1475-6773.2006.00626.x
Preston, D.C. & Shapiro, B.E. (2013). Electromyography and neuromuscular disorders (3rd ed.). Elsevier
Razmjou, H., Robarts, S., Kennedy, D., McKnight, C., MacLeod, A. M., & Holtby, R. (2013). Evaluation of an advanced-practice physical therapist in a specialty shoulder clinic: Diagnostic agreement and effect on wait times. Physiotherapy Canada, 65(1), 46–55. https://doi.org/10.3138/ptc.2011-56
Sonis, J. D., Aaronson, E. L., Lee, R. Y., Philpotts, L. L., & White, B. A. (2018). Emergency department patient experience: A systematic review of the literature. Journal of Patient Experience, 5(2), 101–106. https://doi.org/10.1177/2374373517731359
Sutton, M., Govier, A., Prince, S., & Morphett, M. (2015). Primary-contact physiotherapists manage a minor trauma caseload in the emergency department without misdiagnoses or adverse events: an observational study. Journal of Physiotherapy, 61(2), 77–80. https://doi.org/10.1016/j.jphys.2015.02.012
Trzeciak, S., & Rivers, E. P. (2003). Emergency department overcrowding in the United States: An emerging threat to patient safety and public health. Emergency Medicine Journal, 20(5), 402–405. https://doi.org/10.1136/emj.20.5.402
Wrensch, M., Lee, M., Miike, R., Newman, B., Bargar, G., Davis, R., & Neuhaus, J. (1997). Familial and personal medical history of cancer and nervous system conditions among adults with glioma and controls. American Journal of Epidemiology, 145(7), 581–593. https://doi.org/10.1093/oxfordjournals.aje.a009154
Yarmohammadian, M. H., Rezaei, F., Haghshenas, A., & Tavakoli, N. (2017). Overcrowding in emergency departments: A review of strategies to decrease future challenges. Journal of Research in Medical Sciences, 22, 23. https://doi.org/10.4103/1735-1995.200277
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