THE USE OF PATIENT SYMPTOMS TO SCREEN FOR SERIOUS BACK PROBLEMS

Even when a patient is referred by a physician, the physical therapist must remain alert to the possibility that the patient may require med ical care outside the realm of physical therapy. Physical therapists m ust be able to screen low back pain patients to identify those who hav e serious low back problems which require additional diagnostic evalua tion and treatment by a physician. It is important for physical therap ists to know which symptoms and signs or combination of symptoms and s igns best indicate the likelihood of a serious problem. The purpose of this study was to test the sensitivity and specificity of low back pa in symptoms in distinguishing individuals with a benign low back probl em from those requiring surgical or medical intervention. Demographic and clinical data were collected retrospectively from a standardized l ow back pain questionnaire located in the medical records of 174 low b ack pain patients. Patients were classified as having a benign low bac k problem (N = 41) or a serious low back problem (N = 133) based on su rgical findings or long term follow-up. Some individual symptoms had h igh specificity, but none had high sensitivity. To improve sensitivity while attempting to maintain moderate specificity, a number of sympto ms were considered in parallel. The highest combination of sensitivity (.87) and specificity (.50) was obtained by combining in parallel the symptoms of unable to sleep, awakened and unable to fall back to slee p, medication required to sleep, and pain worsened by walking.