Abstract
Purpose
To evaluate the competencies of spinal extended scope physiotherapists (ESP) following the introduction of requesting rights for magnetic resonance imaging (MRI) one year later.
Methods
From September 2009 to August 2010 each MRI scan requested by the 2 spinal ESPs within the orthopaedic clinic was recorded along with their clinical diagnosis to ascertain why the scan was requested. This was indicated on a four point scale of likelihood of pathology which had been introduced to give evidence for MRI requesting rights. This was then audited to determine the total number of scans requested along with the accuracy or justification of the request.
Results
589 patients in total were seen in the time period by 2 spinal ESPs and of these 193 (33%) were referred for MRI scans. The breakdown of figures for the diagnosis showed that 18% of scans were for possible serious spinal pathology (SSP). 66% for lumbar spine/radiculopathy, 11% for cervical spine/radiculopathy, 2% thoracic and 3% were consideration for surgery eg. possible fusion.
The accuracy of diagnosis, as measured by the clinical impression within a 4 point scoring system and its concordance with the MRI result indicated that for the lumbar spine accuracy rate was 71%, for the cervical spine 62.5%, Myelopathy 50%, SSP 16%.
Conclusion
It is important that the requesting of MRIs by members of the orthopaedic team other than spinal consultants can be audited to demonstrate competency of clinical assessment and examination within the team. This results in cost effectiveness in requesting imaging appropriately according to patient needs rather than blanket referrals for scans which can be unnecessary. Data will continue to be collected and a report produced on an annual basis to ensure continuing competency.
