Diagnosis of Spinal Pain – Research Evidence
For this post I wanted to continue the trend of posts regarding the usefulness of clinical tests to diagnose specific “structural” dysfunctions. The previous post being about the hip, this post being about “spinal” clinical tests.
How useful are our clinical tests in the diagnosis of spinal pain?
I think the article by Cook and Hegedus (2011) provides a wonderful summary of this issue. I have reproduced the following two tables from their article, all credit to the authors.
For a reminder about “screening vs diagnostics”, and what “sensitivity”, “specificity” and “LR’s” mean, please refer back to this post.
My thoughts:
- I look at the above and conclude that a significant number of our spinal clinical tests have poor use as diagnostic tests.
- We should take care “labelling” a patient as a having a specific diagnosis when many of our clinical tests cannot tell us reliably that this is what is actually occurring.
- Some are good screening tools, but many are of no use whatsoever apart from as pain provocation tests (if a test reproduces the patients symptoms we can at least use it as a re-test procedure to ascertain effectiveness of treatment).
- We can use many tests as a screening tool (highly sensitive tests) to confidently say to patients that:
The tests for this “problem” are negative therefore we can be confident that you do not have that “problem”.
My view on diagnosis anyway is that it is the smallest, and least significant, aspect of the patients presentation. Before you all fire away at me, I count classification of the patients presentation as separate to the diagnosis!! More on this to come. Thanks for reading. As always I welcome discussion.
References:
About the Author: Mark Gibson
Mark is a Specialist Musculoskeletal Physiotherapist who consults at both Insight Physiotherapy and Pain Options, in Perth, Western Australia. He specialises in the assessment and management of persistent/chronic musculoskeletal pain. In addition to his clinical role he maintains regular involvement in education of the profession having held a Teaching Fellow position at the University of Western Australia for 10 years and regularly presenting at courses and seminars through the Australian Physiotherapy Association and private education sector. Mark is also a Facilitator for the Australian College of Physiotherapists Specialisation Training Program and a Sessional Academic at Curtin University. The views expressed on this blog are his own.Subscribe
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I agree that the diagnosis is the least important for the therapist, as we deal with the cause, underlying mechanisms that contribute to the painful experience. I share with my colleagues that I usually classify each diagnosis with broad classification system, largely based on O’Sullivan’s classification system and the likely pain type. However, the diagnosis is important to the client, as they often relate their pain to a “disease” because the society is brought up to pathologise pain, and for every pathology, there is a standard method to treatment. It is then our responsibility to educate the clients! Good job I love reading your website.
Thanks for the comment GJ.
I couldn’t agree more with your approach. As you can probably gather from my blog i approach assessment and management of patients in much the same way as you and, whilst I might be biased, I think this is the current best evidenced based practice way to do so.
Thanks for reading and participating.
Cheers
Mark