DOCUMENTATION OF BACK PAIN AND/OR DISORDERS IN INDIVIDUALS WITH PARKINSON DISEASE BY PHYSICAL THERAPISTS AND NEUROLOGISTS

Abstract

Purpose/Hypothesis: Back pain is a common complaint in individuals with Parkinson disease (PD) and often interferes with their performance of daily activities. Patients with PD also develop flexion postures which health professionals typically treat by prescribing back extension exercises. However, performance of back extension exercises without appropriate modifications may exacerbate pain and lead to greater disability in individuals with PD who have concomitant back disorders such as spinal stenosis and osteoporosis. In an effort to identify a potentially harmful practice issue, this study examined the documentation of back pain, diagnosis, and treatment by neurologists and physical therapists (PTs) in patients with PD. We hypothesized that PTs would more frequently document concurrent back problems and exercise modifications than neurologists because of PTs specific training in the evaluation and treatment of musculoskeletal disorders. Number of Subjects: Eighty-four medical records of patients diagnosed with PD were reviewed. Materials/Methods: Medical records were reviewed retrospectively to quantify documentation of 1) back pain or back disorders including spinal stenosis and osteoporosis; 2) confirmatory diagnostic tests (i.e., MRI, CT scan, or bone mineral test) for back disorders; and 3) modifications of exercise regimens based on back pain or disorders. All documentation over a two year period was done by one of two neurologists or PTs. Medical record reviews were conducted by individuals who were not involved in patient care. Results: Forty-two out of the 84 patients with PD reported back pain and/or back disorders. Among the 31 patients who reported back disorders, only 18 (58%) charts contained diagnostic results that confirmed the disorder. Therapists were more likely to document back pain complaints and neurologists were more likely to document back disorders. In twenty out of 28 patients (71%) with reported back pain, the physical therapist documented that the exercise prescription was modified to accommodate the back pain. Conclusions: Back pain and/or back disorders were frequently documented in patients with PD. However, confirmation of back disorders was poorly documented. PTs more frequently documented back pain complaints and synthesized back pain and disorder information to modify exercise prescriptions than neurologists. Clinical Relevance: Without proper identification and documentation of back pain and/or disorders in individuals with PD, health professionals may fail to modify traditionally prescribed back extension exercises or implement fracture prevention interventions, possibly leading to severe back pain and disability in affected individuals. Patients with back pain are unlikely to comply with exercises for PD if they experience increased pain with or after standard PD exercise programs. Proper identification of individuals with PD with concurrent back problems and modification of their exercise regimens is crucial.