Physicals lacking in low back pain care
Researchers Doubt Accuracy of Red Flags to Detect Spinal Malignancy
HealthDay News -- Among adults with low back pain who visited a physician, 43% report no physical inspection and 20% report no palpation at physician encounters, according to study findings.
"The physical examination is a cornerstone of any evaluation of patients with low back pain. With increasing reliance on diagnostic imaging, there is concern that patients are not being examined comprehensively, but to our knowledge, no studies have ever investigated how often the physical examination is performed," Joel Press, MD, from Northwestern University in Chicago, and colleagues reported in Spine.
So they surveyed 295 patients regarding the types of physicians they had seen for low back pain within the past year. For each physician encounter, the patients were asked whether or not they had removed their clothes or put on a gown or shorts during the examination (a proxy for inspection) and whether the provider had placed his or her hands on the patient (a proxy for palpation).
For the 696 physician visits analyzed, inspection was performed at 57% of the encounters. Orthopedic surgeons had the highest reported rate of inspection at 72%, whereas chiropractors inspected 40% of the time (the lowest among specialties).
Palpation occurred at 80% of physician encounters, with chiropractors having the highest rates (94%) and neurosurgeons having the lowest (58%).
"These numbers reflect a need for improvement among providers who treat patients with low back pain," the researchers wrote.