{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:17:01Z","timestamp":1753877821438,"version":"3.41.2"},"reference-count":65,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T00:00:00Z","timestamp":1621296000000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The most commonly reported vector-borne and tick-borne disease in the United States is Lyme disease. Individuals with Lyme disease may present with a wide array of symptoms with resultant musculoskeletal, neurological, and cardiac manifestations that may cause them to seek physical therapist services. The symptoms may develop insidiously and with a variable presentation among individuals. Many persons with Lyme disease do not recall a tick bite or present with an erythema migrans rash, which is considered pathognomonic for the disease. Even if they do, they may fail to associate either with their symptoms, making the diagnosis elusive. It is important to diagnose individuals early in the disease process when antibiotic treatment is most likely to be successful. Physical therapists are in a unique position to recognize the possibility that individuals may have Lyme disease and refer them to another practitioner when appropriate. The purpose of this article is to (1) present an overview of the etiology, incidence, and clinical manifestations of Lyme disease, (2) review evaluation findings that should raise the index of suspicion for Lyme disease, (3) discuss the use of an empirically validated tool for differentiating those with Lyme disease from healthy individuals, (4) discuss the current state of diagnostic testing, and (5) review options for diagnosis and treatment available to individuals for whom referral is recommended.<\/jats:p>","DOI":"10.1093\/ptj\/pzab128","type":"journal-article","created":{"date-parts":[[2021,5,14]],"date-time":"2021-05-14T19:10:29Z","timestamp":1621019429000},"source":"Crossref","is-referenced-by-count":0,"title":["Physical Therapist Recognition and Referral of Individuals With Suspected Lyme Disease"],"prefix":"10.1093","volume":"101","author":[{"given":"Jennifer","family":"Shea","sequence":"first","affiliation":[{"name":"Retired Adjunct Faculty , Physical Therapy Department, , 263 Alden Street, Springfield, MA 01109 USA"},{"name":"Springfield College , Physical Therapy Department, , 263 Alden Street, Springfield, MA 01109 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,5,17]]},"reference":[{"volume-title":"Guide to Physical Therapist Practice 3.0","year":"2014","key":"2023011906400589600_ref1"},{"key":"2023011906400589600_ref2","first-page":"1","volume-title":"Differential Diagnosis for Physical Therapists: Screening for Referral","author":"Goodman","year":"2013","edition":"5th"},{"key":"2023011906400589600_ref3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss6622a1","article-title":"Surveillance for Lyme disease\u2013United States, 2008-2015","volume":"66","author":"Schwartz","year":"2017","journal-title":"MMWR Surveill Summ"},{"volume-title":"Tick-borne diseases","year":"2011","author":"National Institute for Occupational Safety and Health","key":"2023011906400589600_ref4"},{"key":"2023011906400589600_ref5","doi-asserted-by":"crossref","first-page":"158","DOI":"10.2174\/1874205X01206010158","article-title":"Chronic Lyme disease and co-infections: differential diagnosis","volume":"6","author":"Berghoff","year":"2012","journal-title":"Open Neurol J."},{"key":"2023011906400589600_ref6","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-018-34393-9","article-title":"Evaluating polymicrobial immune responses in patients suffering from tick-borne diseases","volume":"8","author":"Garg","year":"2018","journal-title":"Sci Rep."},{"key":"2023011906400589600_ref7","doi-asserted-by":"crossref","DOI":"10.1093\/med\/9780199937837.003.0159","author":"Halperin","year":"2017","journal-title":"Nervous system Lyme disease"},{"author":"Lyme disease: transmission","key":"2023011906400589600_ref8","article-title":"Centers for Disease Control and Prevention"},{"key":"2023011906400589600_ref9","doi-asserted-by":"crossref","first-page":"499","DOI":"10.3201\/eid2702.202728","article-title":"Use of commercial claims data for evaluating trends in Lyme disease diagnoses, United States, 2010\u20132018","volume":"27","author":"Schwartz","year":"2021","journal-title":"Emerg Infect Dis."},{"key":"2023011906400589600_ref10","doi-asserted-by":"crossref","first-page":"616","DOI":"10.3201\/eid2702.202731","article-title":"Estimating the frequency of Lyme disease diagnoses, United States, 2010\u20132018","volume":"27","author":"Kugeler","year":"2021","journal-title":"Emerg Infect Dis."},{"key":"2023011906400589600_ref11","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.3201\/eid2108.141878","article-title":"Geographic distribution and expansion of human Lyme disease, United States","volume":"21","author":"Kugeler","year":"2015","journal-title":"Emerg Infect Dis."},{"volume-title":"Lyme disease. 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