REFERRAL GUIDELINES PHYSIOTHERAPY

Transcription

1 REFERRAL GUIDELINES PHYSIOTHERAPY Referral Form: Please use the MRI01 Consultation & Medical Referral Form NB Internal Monash Health referrals are only accepted. We do not accept GP or private consultant referrals. Please see For our private practice Kanooka Physiotherapy Group. Click on category to advance to that page: Musculoskeletal Paediatrics Mechanical Low Back Pain Development Dysplasia of the Hip (DDH) Mechanical Low Back Pain with Leg Pain Congenital Talipes Equino Varus (CTEV, Club Foot) & Positional Talipes Osteoarthritis Patella Subluxation/dislocation/knee pain Hips Post-Operative Orthopaedics & Soft Tissue injuries Knees Post inpatient stay (eg. Mobility progression, deconditioned) Spine Rheumatology conditions (JIA) Shoulder Brachial Plexus Paralysis (Erb s Palsy) Mechanical Neck Pain Neonatal developmental follow up Neck Pain associated with referred pain to Referrals from Children s Cancer Centre the upper arm without neurological deficit Rotator Cuff Tendinitis/Tears Pain/stiffness in Shoulder (Frozen Shoulder) Neurology Shoulder dislocation Acute Vestibular AC Joint Dysfunction Complex disability consultation Rotator Cuff Tendinitis/Tears Post stroke management (single discipline) Pain/stiffness in Shoulder (Frozen Shoulder) Spasticity Assessment & Management Elbow Tendinitis Splinting and casting Elbow Stiffness Painful / Stiff wrists Lymphoedema Anterior Knee Pain Cancer related Lymphoedema (arms, legs, breast, genital, head and neck) Patella Dislocation Lymphoedema Prevention Service (For MH Breast Cancer patients only) Achilles Tendon Pathology Treatment of shoulder movement issues following treatment for Breast Cancer (For MH Breast Cancer patients only) Heel Pain TRAM / DIEP / Lat Dorsi flap rehabilitation Plantar Fasciitis Bursitis Pre-patella Cardiorespiratory Trochanteric Cystic Fibrosis Olecranon Bronchiectasis (For MH Breast Cancer patients only) NB please refer using Lymphoedema Service Referral Form IMPORTANT: The following information is mandatory: Demographic: Full name Date of birth Next of kin Postal address Landline & mobile number Medicare number Referring GP details Usual GP (if different) Interpreter requirements Clinical: Reason for referral Management to date and response to treatment Past medical history Current medications and medication history if relevant Functional status Psychosocial history Dietary status Family history Diagnostics as per referral guidelines HEAD OF UNIT Stuart Cavill Senior Manager Physiotherapy PROGRAM DIRECTOR Kerry May ENQUIRIES P: F: (03) Review Dec

2 Click on category to advance to that page: Women s & Men s Health Urinary and Faecal Incontinence (Male & Female) Voiding difficulty (Male & Female) Pelvic Organ Prolapse Pelvic Pain (Male & Female) DRAM Diastasis of the Rectus Abdominus Muscle (Postnatal only) Obstetric Musculoskeletal symptoms (antenatal and up to 3/12 postnatal) Spine Pelvis Thoracic Carpal tunnel Physiotherapy antenatal education classes Services not provided Referrals from GPS or Private consultants Exercise Physiology Post Physiotherapy referral for any of the above related conditions: for exercise specific rehabilitation & therapy Pulmonary Rehabilitation - Please refer to Monash Health Community via IMPORTANT: The following information is mandatory: Demographic: Full name Date of birth Next of kin Postal address Landline & mobile number Medicare number Referring GP details Usual GP (if different) Interpreter requirements PLEASE NOTE: All referrals received by Monash Health are triaged by clinicians to determine urgency of referral. Patients assessed as having an urgent need are offered an appointment within thirty days as assessed by the clinician. Patients assessed as having a non-urgent need for appointments, referrers and patients will be notified of the expected wait times. Alternative service providers can be found by searching the Human Services Directory at Clinical: Reason for referral Management to date and response to treatment Past medical history Current medications and medication history if relevant Functional status Psychosocial history Dietary status Family history Diagnostics as per referral guidelines HEAD OF UNIT Stuart Cavill Senior Manager Physiotherapy PROGRAM DIRECTOR Kerry May ENQUIRIES P: F: (03) Review Dec

3 Musculoskeletal Mechanical Low back pain Previous spinal surgery Analgesia Activity modification Referral to pain management clinic Weight loss Please refer to to Monash Health Community via Mechanical Low back pain with leg pain Neurological deficit Previous spinal surgery Analgesia Activity modification Referral to pain management clinic or Rheumatology Weight loss Emergency if bilateral sciatica with perineal sensory disturbance, sphincteric disturbance with or without progressive neurological symptoms - Straight to Emergency Department Or If functional impairment despite conservative treatment after six weeks Duration of symptoms Mechanical Neck pain Previous spinal surgery Analgesia Activity modification Referral to pain management clinic or Rheumatology Weight loss Please refer to to Monash Health Community via Neck Pain associated with referred pain to the upper arm without neurological deficit Neurological deficit Previous spinal surgery Weight loss, appetite loss and lethargy Fever and sweats Previous malignant disease Analgesia Activity modification Referral to pain management clinic Weight loss Urgently to Orthopaedics if any of the key points in red. Or If functional impairment despite conservative treatment after six weeks Duration of symptoms to to Monash Health Community via

4 Musculoskeletal cont Neck pain associated with radicular symptoms and neurological deficit Urgently to Orthopaedics if any of the key points in red. Neurological deficit Previous spinal surgery Weight loss, appetite loss and lethargy Fever and sweats Previous malignant disease Analgesia Activity modification Referral to pain management clinic Weight loss Or If functional impairment despite conservative treatment after six weeks Duration of symptoms to Monash Health Community via Rotator Cuff Tendinitis/Tears Analgesia / anti-inflammatories Consider Ultrasound guided cortisone injection Please refer If functional impairment despite conservative treatment or evidence of weakness Pain/stiffness in Shoulder (Frozen Shoulder) Analgesia / anti-inflammatories Consider a hydrodilatation injection Please refer to Monash Health Community via Shoulder dislocation Please refer urgently to Physiotherapy Analgesia / anti-inflammatories Sling AC Joint Dysfunction Please refer routinely to Physiotherapy Analgesia / anti-inflammatories Consider Ultrasound guided cortisone injection 4

5 Musculoskeletal cont Elbow Tendinitis Elbow Stiffness Painful / Stiff wrists Please refer routinely to Physiotherapy Analgesia / anti-inflammatories DO NOT consider cortisone injection Activity modification Supports- Tennis elbow strap Work Assessment Osteoarthritis Hips Knees Spine Shoulder Walking distance Rest pain & disturbance of sleep Ability to put shoes on Use of Gait Aids Analgesia / anti-inflammatories (with guidance around taking analgesics prior to exercise/walking) Weight loss Activity modification including the use of Gait aids Arthritis Victoria Waves warm water program Information/Our-Services/Waves- Warm-Water-Exercise-Program Nutrition & Dietetics if BMI >32 Consider Ultrasound guided cortisone injection for Shoulder Please refer to Monash Health Community via Anterior Knee Pain (including Chondromalacia Patella) Patella Dislocation Analgesia / anti-inflammatories Activity modification Supports- Patella Knee strap / knee brace for dislocations Please refer routinely to Physiotherapy; if chronic condition please refer to Monash Health Community via Achilles Tendon Pathology Heel Pain Plantar Fasciitis Please refer routinely to Physiotherapy Analgesia / anti-inflammatories Consider cortisone injections to bursa Activity modification Orthoses Community podiatry - Monash Health Community via

6 Musculoskeletal cont Bursitis Pre-patella Trochanteric Olecranon Please refer routinely to Physiotherapy Analgesia / anti-inflammatories Consider cortisone injections to bursa Avoid repeated injections Activity modification Knee Meniscal degenerative tear on MRI Analgesia / anti-inflammatories (with guidance around taking analgesics prior to exercise/walking) Weight loss Activity modification including the use of Gait aids Arthritis Victoria Waves warm water program information/our-services/waves- Warm-Water-Exercise-Program Nutrition & Dietetics if BMI >32 If true mechanical locking/giving way please refer to Orthopaedics; if not refer to physiotherapy - Monash Health Community via If acute locked knee unable to extend refer to ED Post-operative Orthopaedics/Plastics from Monash Health Please refer urgently to Physiotherapy Analgesia / anti-inflammatories Activity modification Acute ligamentous knee/ankle injury Analgesia / anti-inflammatories Activity modification Bracing Acute knee injury with mechanical instability/giving way refer to ortho If no giving way, refer to physiotherapy 6

7 Paediatrics Development Dysplasia of the Hip (DDH) If unstable Urgently to Physiotherapy Nil Congenital Talipes Equino Varus (CTEV, Club Foot) Please refer urgently to Physiotherapy Nil Patella Subluxation Please refer routinely to Physiotherapy Bracing Post-Operative Orthopaedics, including fractures. Please refer routinely to Physiotherapy if stiff post removal of plaster casts, problems with mobility Analgesia / anti-inflammatories Activity modification Bracing Brachial Plexus Paralysis (Erb s Palsy) Please refer urgently to Physiotherapy Nil 7

8 Women s & Men s Health Urinary and Faecal Incontinence (Male & Female) Voiding Difficulty (Male & Female) Please refer routinely to Physiotherapy Pelvic examination MSU Caffeine reduction Consider trial of anticholinergic medication if predominantly urge or urge incontinence Pelvic Organ Prolapse (POP) Please refer routinely to Physiotherapy Symptomology lump, something coming down, dragging discomfort, vaginal laxity, difficulty with defaecation / micturition, dyspareunia, voiding difficulty, urinary incontinence Pelvic examination MSU Vaginal Oestrogen in post menopausal woman Pelvic Pain (Male & Female) Please refer routinely to Physiotherapy try to determine if gynaecological or bowel in origin and exclude constipation / IBS Pelvic examination MSU Pelvic ultrasound Referral to Chronic Pelvic Pain Clinic (MMC Moorabbin) DRAM Diastusis of the Rectus Abdominus Muscle (Postnatal only) NB we do not see these patients antenatally Abdominal examination palpate separation above, below and at umbilicus Please refer routinely to Physiotherapy when a clinically significant DRAM only (> 4cm at umbilicus) Abdominal support tubigrip / firm fitting underwear Avoid strenuous abdominal exercise 8

9 Women s & Men s Health cont Obstetric Musculoskeletal symptoms (antenatal and up to 3/12 postnatal) Spine Pelvis Thoracic Carpal tunnel Please refer routinely to Physiotherapy Neurological defect Maternity support belt Heat pack Activity modification Simple analgesia Antenatal Education Classes for all women planning to give birth at Monash Health Classes are delivered at MMC Clayton, Dandenong and Casey Early pregnancy session - Looking after yourself during pregnancy - Exercise during pregnancy Late pregnancy session - Coping with labour (including TENS) - Post birth recovery Classes can be booked via the Physiotherapy Department or Antenatal Clinic Classes complement Childbirth Education classes so patients should attend both classes Neurology Acute Vestibular Please refer Urgently to Physiotherapy Nil Spasticity Assessment & Management Please refer routinely to Physiotherapy Nil Stroke Management Please refer routinely to Physiotherapy Nil 9

10 Lymphoedema Cancer related Lymphoedema Cancer treatment to date. Please state if client has active disease PMH please state if client has cardiac or PVD issues, liver, kidney or thyroid disease. Drug history please state if client is currently taking medication that causes or exacerbates oedema Skin care to prevent cellulitic episodes Elevation above heart height Limb exercise to facilitate muscle pump Private manual lymphatic drainage massage TED stockings not tubigrip Frusemide will worsen lymphoedema longterm unless concurrent cardiac issue As soon as possible once symptomatic of oedema early detection and treatment are vital to halt progression and maximise volume reduction Treatment of shoulder movement issues following treatment for Breast Cancer eg frozen shoulder, cording (axillary web syndrome) *** funded for Monash Health Breast Cancer Patients only*** Cancer treatment to date Whether shoulder issue is inhibiting ability to proceed with radiotherapy History of seroma / haematoma / prolonged drainage or cellulitis post op As soon as possible once symptomatic early detection and treatment are vital to regaining movement Encourage exercises taught at PAC and admission TRAM / DIEP / Lat Dorsi flap rehabilitation ***funded for Monash Health Breast Cancer patients only*** Need for abdominal binder Scar or herniation issues prohibiting progression of abdominal exercises and shoulder stretching Encourage exercises taught at PAC and admission As soon as possible once symptomatic early detection and treatment are vital to regaining movement 10

11 Exercise Physiology Musculoskeletal injury including but not limited to: LBP Shoulder injury Knee/ankle injury Achilles tendon pathology OA: hip, knee, spine, shoulder Paediatric musculoskeletal conditions Exercise Physiology initial assessment: History of presenting condition, medical history Examination: ROM, strength, endurance, CV capacity, physiological parameter testing Medications Social History Past Exercise history Current exercise & goals Home Exercise Program implementation Referral to Aquatic Exercise Physiology Referral to Supervised Gym group EP service Referral to community based group programs: specific OA group, Strength group Referral to weight loss community program: weigh to go Once patient has been treated in physiotherapy in the acute stage of presentation & physiotherapist deems patient is physically ready for exercise rehabilitation. Patient is medically stable for exercise participation. Patient has objective rehabilitation goals. OA: hip, knee, spine, shoulder Exercise Physiology initial assessment: History of presenting condition, medical history Examination: ROM, strength, endurance, CV capacity, physiological parameter testing Medications Social History Past Exercise history Current exercise & goals Refer to community EP: Cranbourne, Dandenong, Springvale, Clayton: Fax referral: Home Exercise Program implementation Referral to Aquatic Exercise Physiology Referral to Supervised Gym group EP service Referral to community based group programs: specific OA group, Strength group Referral to weight loss community program: weigh to go Post-operative Orthopaedics from Physiotherapy Exercise Physiology initial assessment: History of presenting condition, medical history Examination: ROM, strength, endurance, CV capacity, physiological parameter testing Medications Social History Past Exercise history Current exercise & goals Home Exercise Program implementation Referral to Aquatic Exercise Physiology Referral to Supervised Gym group EP service Referral to community based group programs: specific OA group, Strength group Referral to weight loss community program: weigh to go if appropriate Once patient has been treated in physiotherapy in the acute stage of presentation & physiotherapist deems patient is physically ready for exercise rehabilitation. Patient is medically stable for exercise participation. Patient has objective rehabilitation goals. 11

12 Exercise Physiology cont Women s & Men s Health: Obstetric Musculoskeletal symptoms: Spine Pelvis Thoracic Carpal tunnel Pelvic Pain (Male & Female): SIJ Pain Exercise Physiology initial assessment: History of presenting condition, medical history Examination: ROM, strength, endurance assessment, CV capacity, physiological parameter testing Medications Social History Past Exercise history Current exercise & goals Referral to Aquatic EP program (Dandenong Hospital) Referral to community hydrotherapy Referral to community group/1:1 Exercise Physiology Once patient has been treated in physiotherapy in the acute stage of presentation & physiotherapist deems patient is physically ready for exercise rehabilitation. Patient is medically stable for exercise participation. Patient has objective rehabilitation goals. Cardiorespiratory Cystic Fibrosis On suspected diagnosis of cystic fibrosis Lung function testing Hard copy of imaging as able with results Advice Bronchiectasis On confirmed diagnosis of bronchiectasis Lung function testing Hard copy of imaging as able with results Advice regarding humidification and increasing physical activity 12