Examination in Physical Therapy Practice: Screening for Medical Disease.

The basic premise of this multi-authored text is that physical therapists should have the knowledge and clinical tools necessary to medically screen patients for the presence of symptoms or conditions that would normally require the knowledge and expertise of a physician. The primary objective of the book is to supply the requisite information necessary to screen the various body systems for medical disease. The text, made up of 13 chapters written by 22 authors, serves this purpose well in many respects.

The first chapter is a general overview, relating screening for medical disease to physical therapy assessment and treatment principles. It describes those evaluation procedures that will assist the therapist in differentiating between mechanical musculoskeletal dysfunction and disease entities as a source of a patient's complaints; here the reader will find extremely helpful techniques. The next several chapters address the cardiovascular, pulmonary, gastrointestinal, endocrine, and musculoskeletal systems. There are separate chapters for male and female genitourinary system screening. Also included are chapters on screening for rheumatic disease, pathologic origins of head and facial pain, and psychological disorders.

The format is similar for many of the chapters and includes an exposition of the normal anatomy and physiology of the system in question, followed by subjective and objective evaluation techniques that are detailed and comprehensive. A list of common disorders is next, which ends with two illustrative case histories. The latter nicely enhance the preceding clinical material and reinforce the necessity of evaluating the patient totally. Throughout, the book emphasizes a specific analysis of disease processes most likely to present primarily as pain syndromes.

This informative text contains much useful data and many insightful observations about clinical syndromes that can mislead the therapist into thinking he or she is treating a musculoskeletal problem. Although the emphasis in some chapters is supposed to be on diseases that the therapist is most likely to encounter clinically, this is not always the case. The anatomy and physiology review at the beginning of most chapters is unnecessary and adds bulk to the text. This information can be found in other texts. The review of normal pregnancy in the female genitourinary screening section seems superfluous. Some of the topics are far too cursory; in other areas the text seems capricious and lacking in depth. A chapter on clinical pharmacology has useful and accurate information, but seems out of character with the overall theme of the book. The chapter on screening for musculoskeletal disease, however, is excellent in all respects, and the review of psychological disorders, which includes a framework of how physical symptoms are therapeutically addressed from a psychological perspective, is outstanding.

Overall, the book is not uniformly referenced; whereas some chapters are well documented, in others the citations are scarce. Tables supplement the text very well, but illustrations are not extensive. The radiographs in the musculoskeletal chapter are noteworthy. Although a cohesive writing style is usually difficult to attain when using contributions from several different authors, this text demonstrates a consistently smooth and comprehensively readable style, reflecting good editing. Two appendixes, a review of systems summary, and an extensive glossary complete the text.

When this text adheres to its purpose of teaching the therapist when to refer a patient to a physician, it does so in a sophisticated manner and can only augment and advance communication between therapist and physician. Unfortunately, the book strays from its purpose often enough to detract from the overall intent. I recommend this text for any physical therapy practitioner who desires a firmer knowledge base in medical screening.