Differential Diagnosis in Physical Therapy, 2nd ed.

Goodman CC, Snyder TEK. Philadelphia, PA 19106-3399, WB Saunders Co, 1995, paperback, 650 pp, illus, $42.

This book is one of a kind. It is a valuable tool for physical therapists and occupational therapists screening clients for a systemic disease that mimics a musculoskeletal condition. As clients are referred to physical therapists in more acute states of illness or injury, the assessment of musculoskeletal conditions in view of a possible underlying systemic disease becomes a necessity for rehabilitation personnel.

The chapters have been designed to clearly state the clinical signs and symptoms of conditions associated with each body system; an overview of the pattern of pain on the body, with illustrations associated with the condition and the musculoskeletal disorders; guidelines for physician referral and immediate medical attention ; key points to remember that are associated with the system; special questions to ask the client; a case study for most of the conditions discussed in the chapter; and a reference list following each chapter. Some of the chapters have an appendix with common medications, along with the indications and side effects of these medications for the conditions discussed in that chapter.

The first chapter is a general overview of interviewing a client, along with precautions and contraindications to physical therapy, pain patterns, systems review, signs and symptoms of systemic disease, and physician referral. The second chapter is an introduction to the interviewing process and includes appendixes covering the advantages and disadvantages of replacement hormone therapy and guidelines for blood pressure measurement. The subsequent chapters are an overview of the cardiovascular signs and symptoms and the common cardiovascular medications; pulmonary, hematologic, gastrointestinal, renal and urologic, hepatic and biliary, endocrine, and metabolic systems; oncologic signs and symptoms; and immunologic signs and symptoms. The last chapter covers the systemic origins of muscloskeletal pain and its associated signs and symptoms.

The inside cover of the back and front of the book lists normative values for red blood cell count in adults, white blood cell and differential count in children and adults, platelet count, urine analysis, renal blood studies, laboratory tests for liver and biliary tract disease, arterial blood gases, serum etectrolyte levels, and Winningham contraindications for aerobic exercise in clients undergoing chemotherapy. There is an extensive glossary of terms in the latter part of the book.

This book is an excellent textbook for physical therapy and occupational therapy students. It will also become a reference book for the clinical physical therapist and occupational therapist, especially those therapists working in more independent practices, such as home health, private practices, freestanding outpatient facilities, and skilled nursing facilities.

Ms Marzouk is a physical therapist specializing in geriatrics. She has developed and taught a course for home health aides and has written publications on the Americans with Disabilities Act, balance, and administrative topics.