An audit of clinical assessments of low back pain conditions managed at Parirenyatwa hospital’s rehabilitation department: 2 year retrospective study (2010-11)

Abstract

and Aim: Musculoskeletal conditions contributed 62% of all the cases that presented to Parirenyatwa Hospital’s Physiotherapy Outpatient Department during the year 2010-11. Low back pain contributed 13% of these musculoskeletal conditions. Although assessment forms are available at Parirenyatwa, Physiotherapists do not use these preferring to a “helicopter” type of assessment which does not cover all areas of low back pain assessment. This lead the author to investigate the adequacy of such assessments. Methods: A retrospective audit study was carried out on assessment forms used for patients presenting with LBP conditions at Parirenyatwa Hospital’s Physiotherapy Department during 2010-11. A Chartered Society of Physiotherapy (CSP) pro forma was utilized for auditing the records. In addition a focus group discussion (FGD) was carried out with Physiotherapists working at Parirenyatwa. Data were entered into EPI info version 3.5.3 and descriptive statistics used to obtain the frequencies, graphs and tables. Results: A total of 86 assessment forms of patients presenting with low back pain conditions were audited. The most assessed areas under subjective assessment were social and family history (97.7%), presenting condition (96%), past medical history (89.5%), current medications (79.1%), investigations (60.5%) and the least documented were precautions (2.3%), patient’s perceptions (0%) and expectations (0%). The most assessed areas under objective assessment were palpation (81.4%), observation (66.5%), problems (66.3%), and the least documented was impression of clinical diagnosis (7%), and result of outcome measurement (7%). Results of the FGD were that:- clinical supervision, continuous professional development, staff shortage, clinical judgment, work experience, attitude and competence all contributed to what areas were assessed. Conclusion and Recommendation: A “helicopter” assessment leads to inadequate assessment as shown by the results for example patient’s perception and expectations were not addressed, therefore it is necessary to audit assessment forms at regular intervals to ensure quality care.