Guideline Development Group

Summary of Evidence

The Guide to Physical Therapist Practice states that the physical therapy examination is a comprehensive screening and specific testing process leading to diagnostic classification or, as appropriate, to a referral to another practitioner.²⁹ Understanding the factors that place individuals at risk for a VTE is important for all physical therapists. During the patient interview, physical therapists should ask questions and review the medical history to determine if the patient is at risk for LE DVT (Table 1). The relationship between particular risk factors and presence of LE DVT has been found through retrospective and prospective studies and identified as having support from Level I evidence in other clinical practice guidelines.^{18, 30-33}

The need for all healthcare providers to screen for risk of LE DVT through system wide approaches has been highlighted by the US Agency for Healthcare Research and Quality³⁴, Finnish Medical Society³⁰ and Scottish Intercollegiate Guidelines Network³⁵ and is strongly recommended by each of these groups. Furthermore, the importance of screening was strongly supported in a 2008 multi-national cross sectional study of patients from over 350 hospitals across 32 countries. Findings revealed that 39.5% of patients at risk for VTE were not receiving appropriate prophylaxis.³⁶ Hospital wide strategies were recommended to assess patient’s VTE risk and to monitor whether those at risk received appropriate prophylaxis.

To facilitate and standardize the process of screening for risk within healthcare systems and across professions, assessment models (RAM) should be considered.^{35, 37} Risk assessment models use a checklist to determine if risk factors for LE DVT are present and each risk factor is assigned a point value. If a set point level is reached, the patient is considered at an increased risk and more aggressive prophylactic interventions can be used. There are numerous examples of RAMs in the literature including the Padua Score for assessing VTE Risk in Hospitalized Patients³⁸, the IMPROVE VTE RAM³⁹, the Autar DVT Risk Assessment Scale⁴⁰ and the Geneva Risk Score⁴¹. None have been shown to be superior to others through direct comparisons and for this reason, the GDG cannot recommend a single RAM. It is more important that physical therapists work within their healthcare system to understand and even help develop an overall VTE protocol that uses an agreed upon tool for VTE risk assessment.

In summary, given the risks and harms associated with a VTE and relationship of VTE incidence to the presence of risk factors, physical therapists should screen for VTE risk. These results should be communicated with the rest of the healthcare team.