Survey of Inspection and Palpation Rates Among Spine Providers

Press, Joel M.; Liem, Brian; Walega, David R.; Garfin, Steven R.

doi:10.1097/brs.0b013e31829ff32f

Cited by 5 publications

(2 citation statements)

References 22 publications

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“…Physical examination (PE) has been one of the cornerstones of the evaluation and treatment of patients for thousands of years [1, 2]. Although training of PE is a core element in undergraduate medical education (UME) it is only irregularly taught in postgraduate medical education (PME) [3].…”

Section: Introductionmentioning

confidence: 99%

“Princess and the pea” – an assessment tool for palpation skills in postgraduate education

2019

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Background In osteopathic medicine, palpation is considered to be the key skill to be acquired during training. Whether palpation skills are adequately acquired during undergraduate or postgraduate training is difficult to assess. The aim of our study was to test a palpation assessment tool developed for undergraduate medical education in a postgraduate medical education (PME) setting. Methods We modified and standardized an assessment tool, where a coin has to be palpated under different layers of copy paper. For every layer depth we randomized the hiding positions with a random generator. The task was to palpate the coin or to determine that no coin was hidden in the stack. We recruited three groups of participants: 22 physicians with no training in osteopathic medicine, 25 participants in a PME course of osteopathic techniques before and after a palpation training program, 31 physicians from an osteopathic expert group with at least 700 h of osteopathic skills training. These experts ran the test twice to check for test-retest-reliability. Inferential statistical analyzes were performed using generalized linear mixed models with the dichotomous variable “coin detected / not detected” as the dependent variable. Results We measured a test-retest reliability of the assessment tool as a whole with 56 stations in the expert group of 0.67 ( p < 0.001). For different paper layers, we found good retest reliabilities up to 300 sheets. The control group detected a coin significantly better in a depth of 150 sheets ( p = 0.01) than the pre-training group. The osteopathic training group showed significantly more correct coin localizations after the training in layer depths of 200 ( p = 0.03) and 300 sheets ( p = 0.05). This group also had significantly better palpation results than the expert group in the depth of 300 sheets ( p = 0.001). When there was no coin hidden, the expert group showed significantly better results than the post-training group ( p = 0.01). Conclusions Our tool can be used with reliable results to test palpation course achievements with 200 and 300 sheets of paper. Further refinements of this tool will be needed to use it in complex assessment designs for the evaluation of more sophisticated palpatory skills in postgraduate medical settings.

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Section: Introductionmentioning

confidence: 99%

“Princess and the pea” – an assessment tool for palpation skills in postgraduate education

2019

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“…However, the findings from a physical examination combined with a detailed health history can facilitate differential diagnosis and treatment management. Nevertheless, in a prospective study involving 295 individuals who had consulted a low back pain specialist, 40% of the examinations did not involve inspection of the column, and 20% did not rely on spine palpation 2 ) .…”

Section: Introductionmentioning

confidence: 99%

Can a self-administered questionnaire identify workers with chronic or recurring low back pain?

et al. 2015

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To verify if the Nordic Musculoskeletal Questionnaire (NMQ), Visual Analogue Scale (VAS), Roland-Morris Disability Questionnaire (RDQ) and physical examination of the lumbar spine can identify workers with chronic or recurring low back pain, using health history for reference. Fifty office workers of both sexes, aged between 19 and 55 yr, were evaluated using a standardized physical examination and the NMQ, VAS and RDQ. Discriminant analysis was performed to determine the discriminant properties of these instruments. A higher success rate (94%) was observed in the model including only the NMQ and in the model including the NMQ and the physical examination. The lowest success rate (82%) was observed in the model including the NMQ, RDQ and VAS. The NMQ was able to detect subjects with chronic or recurring low back pain with 100% sensitivity and 88% specificity. The NMQ appears to be the best instrument for identifying subjects with chronic or recurring low back pain. Thus, this self-reported questionnaire is suitable for screening workers for chronic or recurring low back pain in occupational settings.

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Neuropathic low back pain in clinical practice

Baron

Binder

Attal

et al. 2016

European Journal of Pain

191

153

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Background and objectiveLow back pain (LBP) is one of the most common chronic pain conditions. This paper reviews the available literature on the role of neuropathic mechanisms in chronic LBP and discusses implications for its clinical management, with a particular focus on pharmacological treatments.Databases and data treatmentLiterature searches were performed in PubMed, key pain congresses and ProQuest Dialog to identify published evidence on neuropathic back pain and its management. All titles were assessed for relevant literature.ResultsChronic LBP comprises both nociceptive and neuropathic components, however, the neuropathic component appears under‐recognized and undertreated. Neuropathic pain (NP) is challenging to manage. Many patients with chronic LBP have pain that is refractory to existing treatments. Typically, less than half of patients experience clinically meaningful analgesia with oral pharmacotherapies; these are also associated with risks of adverse effects. Paracetamol and NSAIDs, although widely used for LBP, are unlikely to ameliorate the neuropathic component and data on the use of NP medications such as antidepressants and gabapentin/pregabalin are limited. While there is an unmet need for improved treatment options, recent data have shown tapentadol to have efficacy in the neuropathic component of LBP, and studies suggest that the capsaicin 8% patch and lidocaine 5% medicated plaster, topical analgesics available for the treatment of peripheral NP, may be a valuable additional approach for the management of neuropathic LBP.ConclusionsChronic LBP often has an under‐recognized neuropathic component, which can be challenging to manage, and requires improved understanding and better diagnosis and treatment.What does this review add?Increased recognition and improved understanding of the neuropathic component of low back pain raises the potential for the development of mechanism‐based therapies.Open and retrospective studies suggest that agents like tapentadol and topical analgesics — such as the capsaicin 8% patch and the lidocaine 5% medicated plaster — may be effective options for the treatment of neuropathic low back pain in defined patient groups.

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Survey of Inspection and Palpation Rates Among Spine Providers

Abstract: N/A.

Cited by 5 publications

References 22 publications

“Princess and the pea” – an assessment tool for palpation skills in postgraduate education

“Princess and the pea” – an assessment tool for palpation skills in postgraduate education

Can a self-administered questionnaire identify workers with chronic or recurring low back pain?

Neuropathic low back pain in clinical practice

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