A recently published article in Physical Therapy set out to examine the diagnostic labels assigned by OCS credentialed PTs and to determine if these influenced selection of interventions. This article has created a stir and reaction amongst some PTs, so let’s take you through the process of this study, to help understand what exactly it tells us:
1. This study was cross-sectional and looked at the completion of a survey, based upon two written cases, by a potential pool of 877 OCS PTs.
2. The two written cases were sent out. One involved low back pain. The other involved shoulder pain. After reading through the cases, the participating PT took a survey (which involved open and closed ended questions).
3. Five separate investigators took a look at the responses to the open-ended questions and identified “common constructs that represented existing approaches to diagnostic classification in orthopedic physical therapy practice”. If terminology used was not consistent within common constructs, diagnostic label codes were developed. These included: “Impairment”, “Pain Location”, “Pathology/Pathophysiology”, “McKenzie” etc. The investigators then went back and examined the responses a second time and assigned a diagnostic label code to each of the responses.
4. Out of 877 sent surveys, 107 were adequately completed for use for LBP and 103 for the shoulder
5. 90% of the respondents were between the ages of 36-55 and 72% had been in practice for more than 15 years (I found this particularly interesting; the majority of participants were not likely graduates of entry-level DPT programs nor residency graduates prior to obtaining the OCS—I am curious if the results would be different or show more consistency in a younger demographic?)
6. For the LBP case: 32.7% used a pathology/pathophysiology diagnostic label (ex. “Herniated Nucleus Pulposus With Radiculopathy.”). Others: 10.3% used McKenzie diagnostic labels, 1.9% used Pain Location as the diagnostic labels, .9% used practice patterns, 1.9% used movement systems impairments, 3.7% used treatment-based classification. The largest percentage, 48.6%, used a combination ofdiagnostic labeling techniques.
7. For the shoulder case: the majority of the respondents, 57.9%, used pathology/pathophysiology diagnostic labels.
8. In regards to treatment, most participants considered active interventions to be important (less participants considered passive interventions important). Over 80% of the participants, would use functional training and therapeutic exercise to treat the patients in the written cases . This stated, there was no relationship between the types of labels assigned and the perceived importance of the relative interventions. To summarize, the authors stated: “there appears to be no relationship between the labels that the therapists with an OCS certification used for the patient problems provided in the cases and the type of intervention they considered important to manage the patient’s condition.”
So after reading this study, I suspect we need to establish better parameters for developing a “diagnosis”. While the participants in this study didn’t diagnose “incorrectly”, there was inconsistency among the way they arrived at a diagnostic label(they weren’t wrong; they just used different constructs in its development).
In the end, do you believe we need to better develop criteria to distinguish consistency with our ability to assign labels? Or should we simply intervene based upon the patients presentation? What do you think?
Miller-Spoto M, Gombatto SP. Diagnostic Labels Assigned to Patients with Orthopedic Conditions and the Influence of the Label on Selection of Interventions: A Qualitative Study of Orthopedic Clinical Specialists. Phys Ther. Published Online Feb 20, 2014. doi: 10.2522/ptj.20130244