title: The impact of inefficient clinical diagnosis on the cost of managing low back pain.
abstract: The clinical examination remains the pivotal factor in evaluating low back pain (LBP) for decisions concerning compensation and rehabilitation. Many practitioners believe it to be highly reliable, even though existing literature does not support this belief. Not only are there no data supporting the efficacy of clinical diagnosis for LBP, but also published data underscore its many inherent weaknesses. Healthcare risk managers need accurate clinical information to make decisions. If current clinical information is unreliable, then healthcare risk management strategies for LBP must be revised. This article reviews the work of many researchers in their attempts to unravel the problem of diagnosing LBP. The following conclusions were reached: The problem is significant and continues to increase. The problem is rooted in the clinician's strong dependency on reported pain, which may not always be a reliable source of objective information. Quantification of the impact of the objectivity of reported pain on clinical performance demonstrates the need for a independent source of functional data that can improve the diagnosis. Technology exists to complement the clinical examination, improve clinical performance, and thus reduce the cost associated with LBP management. The research results presented in this article unveil disturbing findings for healthcare risk managers. The strong bias clinicians reserve for reported pain may lead them to overrate pathology, treat patients inappropriately, prescribe unnecessary imaging tests, and generate unfounded medical opinions that are responsible for many disputes. Data are presented to demonstrate the financial benefits that result from the introduction of systematic objective controls via technology. These sound management principles allow the risk manager to determine the validity of claims and treatment proposals. Risk managers can then make informed decisions on contentious claims and regulate the large number of clinician-supported disability cases--decisions that represent significant savings.
authors.affiliation: Spinex Medical Technologies, Inc., Montreal, Quebec, Canada.
authors.forename: S A
authors.initials: SA
authors.lastname: Gracovetsky
authors.forename: A
authors.initials: A
authors.lastname: Marriott
authors.forename: M P
authors.initials: MP
authors.lastname: Richards
authors.forename: N M
authors.initials: NM
authors.lastname: Newman
authors.forename: S
authors.initials: S
authors.lastname: Asselin
mesh_terms: D002170:Canada / Q000453:epidemiology; D003363:Cost Control; D017281:Cost of Illness; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D013677:Medical Laboratory Science; D010808:Physical Examination; D010818:Practice Patterns, Physicians'; D012308:Risk Management / Q000379:methods*; D019564:Unnecessary Procedures