AN EVALUATION OF PHYSIOTHERAPY EXTENDED SCOPE PRACTITIONER (ESP) USE OF MRI IN PATIENTS PRESENTING WITH LOW BACK PAIN; A TWO-CENTRE STUDY.

Abstract

Background: Growing demands upon orthopaedic services in the United Kingdom have resulted in increasing waiting times for orthopaedic consultations. The increasing pressure of new government targets has led to role delegation within the NHS. Magnetic Resonance Imaging (MRI) is a limited resource that requires judicious and validated use. We evaluated the use of MRI in the assessment of patients presenting with back pain to a service managed by an Physiotherapy Extended Scope Practitioner (ESP) working in a secondary care referral centre, against the standard as practiced by orthopaedic surgeons in a separate secondary care referral centre without a dedicated operative spinal service.

Methodology: A retrospective review of 130 lumbar MRI scans requested by an ESP service was compared with a retrospective review of 145 lumbar MRI scans requested by orthopaedic surgeons. In both cases cross-site tertiary referral was required if surgery was to be considered. Presenting symptoms and signs, abnormalities detected on the MRI scans and subsequent management were recorded with rate of listing for operative management used as a measure of appropriate MRI usage. Simple descriptive analysis was undertaken.

Results: 82% and 91% respectively of orthopaedic and ESP referrals for MRI had either neurological signs or symptoms. However, a higher rate of neurological signs was reported by ESP 70% versus 42%).

Despite reported differences in patient presentation the abnormal scan rate was comparable (ESP 91%, orthopaedics 92%).

The tertiary referral rate was also comparable (ESP 47%, orthopaedics 37%).

Of the patients referred to the tertiary referral centres the percentage listed for operative intervention was 68% and 72% respectively for ESP and orthopaedic surgeons. In terms of the number of patients investigated by MRI scan 32% and 26% of patients from the ESP and Orthopaedic centres respectively were listed for surgery.

Discussion: This study shows that physiotherapy ESP use of MRI in the investigation of patients presenting with back pain is comparable to orthopaedic surgeons in a centre without a dedicated spinal service. With adequate training and knowledge of red/ yellow flag signs applicable to assessment of spinal problems we support the role of physiotherapy ESPs in the assessment of patients with spine related problems.