title: Diagnostic labels assigned to patients with orthopedic conditions and the influence of the label on selection of interventions: a qualitative study of orthopaedic clinical specialists.
abstract: BACKGROUND
  A variety of diagnostic classification systems are used by physical therapists, but little information about how therapists assign diagnostic labels and how the labels are used to direct intervention is available.
  
  
  OBJECTIVE
  The purposes of this study were: (1) to examine the diagnostic labels assigned to patient problems by physical therapists who are board-certified Orthopaedic Clinical Specialists (OCSs) and (2) to determine whether the label influences selection of interventions.
  
  
  METHODS
  A cross-sectional survey was conducted.
  
  
  METHODS
  Two written cases were developed for patients with low back and shoulder pain. A survey was used to evaluate the diagnostic label assigned and the interventions considered important for each case. The cases and survey were sent to therapists who are board-certified OCSs. Respondents assigned a diagnostic label and rated the importance of intervention categories for each case. Each diagnostic label was coded based on the construct it represented. Percentage responses for each diagnostic label code and intervention category were calculated. Relative importance of intervention category based on diagnostic label was examined.
  
  
  RESULTS
  For the low back pain and shoulder pain cases, respectively, "Combination" (48.5%, 34.9%) and "Pathology/Pathophysiology" (32.7%, 57.3%) diagnostic labels were most common. Strengthening (85.9%, 98.1%), stretching (86.8%, 84.9%), neuromuscular re-education (87.6%, 93.4%), functional training (91.4%, 88.6%), and mobilization/manipulation (85.1%, 86.8%) were considered the most important interventions. Relative importance of interventions did not differ based on diagnostic label (χ2=0.050-1.263, P=.261-.824).
  
  
  CONCLUSIONS
  The low response rate may limit the generalizability of the findings. Also, examples provided for labels may have influenced responses, and some of the label codes may have represented overlapping constructs.
  
  
  CONCLUSIONS
  There is little consistency with which OCS therapists assign diagnostic labels, and the label does not seem to influence selection of interventions.
authors.affiliation: M. Miller-Spoto, PT, DC, OCS, Physical Therapy Department, Nazareth College, Rochester, New York.
authors.forename: Marcia
authors.initials: M
authors.lastname: Miller-Spoto
authors.affiliation: S.P. Gombatto, PT, PhD, Doctor of Physical Therapy Program, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182-7251 (USA). sgombatto@mail.sdsu.edu.
authors.forename: Sara P
authors.initials: SP
authors.lastname: Gombatto
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D026741:Physical Therapy Modalities; D010820:Physicians; D036301:Qualitative Research; D020069:Shoulder Pain / Q000175:diagnosis* / Q000628:therapy; D013038:Specialization; D011795:Surveys and Questionnaires; D014481:United States