Improving the Evaluation of Benign Low Back Pain
Marriott A, Newman N, Gracovetsky S, Richards M, and Asselin S.
Spine
24(10) : in press, 1999.
Abstract
Study design
A
prospective blind study investigated the factors underlying expert clinicians’
decisions for acute, benign low back pain (LBP) diagnosis, compared to an automated
physical examination by Machine (the Spinex International). From this, a strategy to significantly
improve the clinical diagnosis in cases of discordance was determined.
Objectives
To identify
factors in the clinical assessment of LBP that indicate when independent diagnostic
testing would be useful.
Background
The clinical
evaluation of LBP is often dominated by subjective reports of pain. Published medical
literature has underscored several inherent weaknesses of the clinical examination, and
concerns have been raised about its effectiveness for assessing LBP subjects. Thus it has
been proposed that objective measures to complement the clinician’s examination would
be beneficial to the formulation of dependable diagnoses.
Method
Randomly
designated subjects, who were objective or role-playing, were assessed by clinicians and
Machine for diagnosis of low back sprain versus normal. Each subject was compared to a
Gold Standard that was established by LBP experts. Components of the clinical examination
were analyzed to assess which were the most informative to help make a reliable diagnosis.
The information content of the Machine assessment was also analyzed, and a strategy to
complement the clinical diagnosis with the Machine diagnosis determined.
Results
Discordance
between the various components of the clinical examination proved to be a h5 indicator
of the circumstances when the efficacy of the clinical examination dropped below a random
level of decision making. When there was discordance, incorporating the functional
evaluation by Machine into the clinical diagnosis improved the performance of the
clinician. Notably, for non-objective subjects, the accuracy of diagnosis was enhanced by
as much as 69%.
Conclusion
It is
possible to improve the performance of the clinical diagnosis by incorporating a
functional evaluation by Machine when there is discordance between the physical
examination and reported pain.
