title: Comparison of referrals for lumbar spine magnetic resonance imaging from physiotherapists, primary care and secondary care: how should referral pathways be optimised?
abstract: OBJECTIVE
  To compare sensitivity of pathology on imaging between referrals from primary care, physiotherapists, spinal surgeons and other secondary care providers.
  
  
  METHODS
  A retrospective review of 200 consecutive magnetic resonance imaging (MRI) scans of patients' first presentations to radiology for MR lumbar scanning at a tertiary orthopaedic centre. A scan report was defined as positive if there was any evidence of neural compromise. Fisher's exact 2×2 contingency analyses were performed.
  
  
  RESULTS
  Eighty-seven (44%) scans were positive and 113 (57%) were negative. Forty-four percent of scans requested by general practitioners (GPs) were reported as positive compared with 57% of scans requested by physiotherapists. Only 40% and 20% of scans requested by specialist spinal surgeons and non-spinal team secondary care providers were positive, respectively. Physiotherapist referrals for MRI lumbar spine scans were significantly more likely to be positive compared with GPs (P=0.05), spinal surgeons (P=0.03) and others (P=0.004).
  
  
  CONCLUSIONS
  When appropriate, referrals via the extended physiotherapy service should be encouraged, rather than referrals directly from GPs. With appropriate training and in the appropriate clinical context, extended physiotherapy services could include inpatients and could accept outpatient referrals from other secondary care providers and not just from GPs; this would improve efficiency and reduce the workload of the radiology department and the spinal surgical unit.
authors.affiliation: Department of Radiology, Royal Liverpool and Broadgreen NHS Trust, Liverpool, UK. Electronic address: vp0909@hotmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Parmar
authors.affiliation: Department of Physiotherapy, Royal Liverpool and Broadgreen NHS Trust, Liverpool, UK.
authors.forename: L
authors.initials: L
authors.lastname: Thompson
authors.affiliation: Department of Radiology, Royal Liverpool and Broadgreen NHS Trust, Liverpool, UK.
authors.forename: H
authors.initials: H
authors.lastname: Aniq
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D019091:Critical Pathways / Q000458:organization & administration*; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis / Q000534:rehabilitation; D017116:Low Back Pain / Q000175:diagnosis* / Q000534:rehabilitation; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009493:Neurosurgery / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D059825:Physical Therapists / Q000706:statistics & numerical data; D058007:Physicians, Primary Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D063127:Secondary Health Care / Q000706:statistics & numerical data; D006113:United Kingdom; D014850:Waiting Lists
keywords: Efficiency; Lumbar; MRI; Pain; Physiotherapy; Referral