Positive straight-leg raising in lumbar radiculopathy: is documentation affected by insurance coverage?
OBJECTIVE
To evaluate whether differences exist in documentation of straight-leg raising (SLR), based on insurance coverage.


METHODS
Retrospective study.


METHODS
Managed care organization (MCO).


METHODS
Two hundred people with a diagnosis of lumbar radiculopathy or herniated disk were referred to an MCO for authorization of further treatment. Half were self-directed under a personal injury program (PIP) after automobile collisions, and half were covered under a managed care workmen's compensation (WC) program.


METHODS
Not applicable.


METHODS
Documentation of an SLR test, strength, sensation, and/or reflexes were eligible for the study. The results of SLR were coded as 0, 1, or 2, for absent, positive unilateral, and positive bilateral, respectively. Additional information included subject age, sex, date of injury, provider type, and presence of attorney representation


RESULTS
A positive (unilateral, bilateral) SLR in women was 7.4 times more likely if they were covered by PIP than by WC (95% confidence interval [CI], 1.4-38.7; P=.018). For men, a positive SLR was 23.5 times more likely if they were covered by a PIP (95% CI, 2.9-189.9; P=.003). The odds of bilateral SLR (radicular pain on both sides) were even more strongly associated with type of reimbursement. For women, bilateral SLR was 105.1 times more likely if they were covered by a PIP than by WC (95% CI, 11.1-992.6; P<.001). For men, bilateral SLR was 38.9 times more likely if covered by a PIP (95% CI, 11.3-133.6; P<.001).


CONCLUSIONS
Reasons for reporting higher rates of positive SLR in the PIP group include an added incentive to treat, poor knowledge of proper interpretation of the SLR test, and/or an increased exaggeration of symptoms.
Nadler
Scott F
SF
Departments of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103-2499, USA. sfnadler@cs.com
Malanga
Gerard A
GA
Ciccone
Donald S
DS
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000328:Adult; D000367:Age Factors; D002684:Chiropractic / Q000706:statistics & numerical data; D004282:Documentation / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016015:Logistic Models; D008159:Lumbar Vertebrae; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008485:Medical Audit; D009460:Neurologic Examination / Q000706:statistics & numerical data*; D009462:Neurology / Q000706:statistics & numerical data; D010810:Physical and Rehabilitation Medicine / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011843:Radiculopathy / Q000175:diagnosis*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012447:Sacrum; D012737:Sex Factors; D014942:Workers' Compensation / Q000706:statistics & numerical data