Abstract
Purpose
MRI wait times for patients with back related complaints are disturbingly long despite the common consensus that axial imaging is not required to diagnose and treat a majority of these problems. This wait often delays appropriate treatment.
Many unhelpful MRI scan reports lead to unnecessary apprehension for referring doctors and their patients and frequently stimulate additional surgical consultation requests. This problem is aggravated by surgeons requiring axial imaging before scheduling consultation. Most spine surgeons appreciate that an expert interview and exam can identify those patients for whom axial imaging would be useful in diagnosis and treatment.
The purpose of this project was to test the hypothesis: “Advanced practice Orthopaedic physiotherapists with surgical screening training possess the skills in spine specific interview and exam to identify those patients for whom axial imaging would be useful.”
Method
To test this hypothesis 75 patients from three separate clinical cohorts were evaluated. The physiotherapist and Orthopaedic surgeon independently predicted from the clinical interview and exam whether they believed that an MRI scan would be helpful in patient management. The level of agreement was calculated using chance corrected agreement or kappa values. Subsequently the completed MRI scans were reviewed to evaluate whether each prediction was correct.
Results
Minimum kappa values of 0.80 indicate near perfect agreement in the prediction of MRI usefulness and review of the MRI scans themselves confirmed the predictive accuracy.
Conclusion
A qualified Advanced Practice Orthopaedic Physiotherapist can accurately predict those back patients whose care would benefit from an MRI scan.
Screening of patients with back related complaints by these qualified non-physician experts could reduce the number of patients undergoing unhelpful MRI scan thereby helping to diminish the overall waits for appropriate care.
