Clinical library
Clinical Reasoning and Red Flags
Screening for referral, red and yellow flags, and when physiotherapy is not the answer. These four pages share one uncomfortable finding: the checklists the profession teaches most confidently are the ones with the weakest evidence behind them.
Read these correctly
Nothing in this section argues for screening less, referring less, or imaging less in patients who need it. The finding is that individual checklist items are weaker than they are taught to be — which makes clinical judgement more important, not less. Where these pages find a profession-wide error, it runs in both directions: the same review that documents over-imaging documents substantial underuse in the patients who most needed it.
Screening, prognosis, escalation
Published now
Red Flags
46 discrete red flags across 16 guidelines, no consensus on which to use, and a median agreement of zero between neck pain guidelines.
Yellow Flags and STarT Back
The original trial worked. Seven trials across four countries have not agreed since, and predictive validity in older adults is poor.
Imaging in Low Back Pain
The over-imaging story is true and half the finding. Imaging was not performed in 65.6% of patients who presented with red flags.
Screening for Medical Referral
Direct access looks favourable across 28 studies. Across a second review of 13, exactly one assessed clinical safety.
On jurisdiction. Direct access, imaging referral and onward referral rights differ by country and by state, and these pages make no claim about what is permitted anywhere in particular. The evidence describes what physiotherapists have been shown to do well; your regulator defines what you may do.
Using this in clinic
Every figure here is traceable to its source.
Each page reports what the guidelines say, what the diagnostic accuracy studies found, and the gap between them. Where a value could not be verified against the paper it came from, it is not on this page, and the omission is stated rather than filled with a number from a secondary source.