Physiotherapist-led triage of patients with thoracic spine pain in a musculoskeletal assessment clinic: A service evaluation of activity and outcomes

Abstract

BACKGROUND:

Thoracic spine pain and dysfunction (TSPD) has received less attention in the literature compared to the lumbar and cervical spine, which has created challenges for differential diagnosis in the region.

AIMS:

The study purpose was to describe the clinical activity and outcomes of TSPD patients attending a clinical specialist physiotherapist (CSP)-led orthopaedic and rheumatology triage service, known as the ‘Musculoskeletal Assessment Clinic’ (MAC).

METHODS:

The Clinical Audit department of St Vincent’s University Hospital, Dublin, approved this study. A retrospective service evaluation was carried out of patients who attended the MAC with TSPD between August 2012 and October 2015. Data were analysed using descriptive statistics with SPSS version 20.

RESULTS:

Of the n = 5,143 new patients referred to the MAC over a period of 37 months, 88 of these (2%) (mean age 36.66, years sd = 16.61), were referred primarily for TSPD. Sixty nine percent (n = 61) of patients were categorized as non-specific thoracic spine pain (NSTSP) and 18% (n = 16) structural. Seventy-six investigations were requested for 59% (n = 52) of patients and plain radiograph was the most frequently requested (40.8%, n = 31). Eighty percent (n = 70) of patients were independently managed by CSPs, with 16% (n = 14) of patients being referred for a surgical or medical consultant opinion.

CONCLUSION:

The majority (80%) of the patients were independently managed by the CSPs. Presentations of TSPD to a physiotherapy-led triage service in a secondary care setting attributable to underlying serious pathologies appears to be rare. Replication of this study in other healthcare institutions would be useful for corroborating our findings.