title: Survey of inspection and palpation rates among spine providers: evaluation of physician performance of the physical examination for patients with low back pain.
abstract: METHODS
  Survey from July 2011 to April 2012 of adult patients with primary complaint of low back pain (LBP).
  
  
  OBJECTIVE
  To determine the frequency of physical examination being performed by various providers, as measured by frequency of inspection and palpation, of patients with LBP and to describe patient ratings of these examinations.
  
  
  BACKGROUND
  The physical examination is a cornerstone of any evaluation of patients with LBP. With increasing reliance on diagnostic imaging, there is concern that patients are not being examined comprehensively, but to our knowledge, no studies have ever investigated how often the physical examination is performed in patients with LBP.
  
  
  METHODS
  Survey participants were asked to list the types of physicians that they had seen for LBP within the past 1 year and for each physician encounter to answer 2 "yes/no" questions: (1) whether they had removed their clothes or put on a gown or shorts during the examination (our proxy for inspection) and (2) whether the provider had placed his or her hands on the patient (our proxy for palpation). Subjects also provided quality ratings for each provider's physical examination. Main outcome measures included frequency of inspection and palpation and subjects' ratings of each physical examination.
  
  
  RESULTS
  A total of 295 surveys were collected reflecting 696 prior physician encounters. Inspection was done in 57% of physician encounters. Across specialties, orthopedic surgeons had the highest reported rate of inspection at 72%. The worst was among chiropractors at 40%. Palpation occurred in 80% of physician encounters. Chiropractors had the highest rate of palpation at 94%. The lowest rate was among neurosurgeons at 58%.
  
  
  CONCLUSIONS
  Our data suggest that approximately 43% of patient visits for LBP involved no inspection and nearly 20% without palpation. These numbers reflect a need for improvement among providers who treat patients with LBP.
  
  
  METHODS
  N/A.
authors.affiliation: *Rehabilitation Institute of Chicago, Chicago, IL †Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL ‡Department of Anesthesiology, Northwestern University, Chicago, IL; and §Department of Orthopedic Surgery, University of California, San Diego, La Jolla, CA.
authors.forename: Joel
authors.initials: J
authors.lastname: Press
authors.forename: Brian
authors.initials: B
authors.lastname: Liem
authors.forename: David
authors.initials: D
authors.lastname: Walega
authors.forename: Steven
authors.initials: S
authors.lastname: Garfin
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002684:Chiropractic / Q000706:statistics & numerical data; D003625:Data Collection / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000706:statistics & numerical data; D009985:Orthopedics / Q000706:statistics & numerical data; D010173:Palpation / Q000706:statistics & numerical data*; D010808:Physical Examination / Q000379:methods*; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D013122:Spinal Diseases / Q000150:complications; D011795:Surveys and Questionnaires; D055815:Young Adult