The kind of studies I'm looking are blinded where one group of Therapists is given a dx and the other one doesn't. I'm curious if the treatment plan such as frequency, duration, modality usage varies between the two groups.
Do PTs find value diagnostic imaging? Is there predictive value? If so, how does it affect the tx plan?
Fozzy,
I am unaware of any studies that have compared PT's practice patterns in physician referred with medical diagnosis vs physician referred without medical diagnosis. There is sporadic instances where a patient presents with a referral without a diangosis written on it, or they are referred but insurance doesn't require a referral and so we never see a referral form. In my experience, referrals rarely guide treatment. The diagnoses I have seen are non specific and symptom based (i.e. chronic LBP), or an ICD9 code (which often appears to be a time sensitive selection and inaccurate). Or they are anatomical (i.e. DDD) which is not very helpful either. I do remember reading parts of a study/report that mentioned that specific diagnoses are more common among orthopods early in their experience. Study reports can be beneficial, but random tidbits selected out of the report by a physician that he/she feels is relevant to a PT is not helpful at all(i.e. DDD). I do enjoy reading reports and taking it into consideration but isn't there poor coorelation between imaging findings and symptoms, and isn't there strong evidence to support not educating a patient as to the specifics of their pathology, i.e. in LBP? Another issue to consider is that diagnoses are often opinions, they are not definitive. Thus, we do not and should not just read a diagosis and take it as if that's the way it is. Just as you say you leave the report for last, PT's shouldn't be skewed by an opinion. For example, I had a patient a few weeks ago who was referred with dx of lumbar radiculitis. Her symptoms were present in B lateral thigh as burning with prolonged sitting. Lady was in her late 40's, desk job, probably about 140lbs. During day of eval she had no paresthesias and was her day off work, Full TL ROM without pain, negative combined motions, normal reflexes, no weakness, no tenderness in low back, normal sensation. She had tenderness over the inguinal ligament on palpation and almost immediately reproduced her symptoms when I held pressure. She tended to wear tight jeans. Seems like it was meralgia paresthetica so I told her to alternate between standing/sitting at work and wear looser fitting pants, plus some other exercises... Diagnoses are often time sensitive, opinionated and often made by people who don't do a thorough enough job or don't know enough. Diagnoses that would help me personally though would be ones made by a specialist (i.e. ortho, pm&r, rhuematologist) especially those that are rare. I would like to see diagnoses based on multiple factors (i.e. clustor of S/S, exam findings, imaging, patient ADL's/job, etc) vs just body part + pain.
An interesting study I would like to see would be a prospective one, one large group of PT's who have practiced longstanding PT on medical diagnosis referral vs a large group of PT's practicing without referral or medical diagnosis and see how the outcomes vary, practice pattern variance, PT job satisfaction, patient satisfaction, cost, danger, etc.
