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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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European Journal of Physical and Rehabilitation Medicine 2017 Jul 17

DOI: 10.23736/S1973-9087.17.04689-5


language: English

Are patients referred to rehabilitation diagnosed accurately?

Piotr TEDERKO 1 , Marek KRASUSKI 1, Izabella NYKA 1, Jerzy MYCIELSKI 2, Beata TARNACKA 1

1 Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland; 2 Department of Econometrics and Statistics, Faculty of Economics, University of Warsaw, Warsaw, Poland


BACKGROUND: An accurate diagnosis of the leading health condition and comorbidities is a prerequisite for safe and effective rehabilitation. The problem of diagnostic errors in physical and rehabilitation medicine (PRM) has not been addressed sufficiently. The responsibility of a referring physician is to determine indications and contraindications for rehabilitation.
AIM: To assess the rate of and risk factors for inaccurate referral diagnoses (RD) in patients referred to a rehabilitation facility. We hypothesized that inaccurate RD would be more common in patients 1) referred by non-PRM physicians; 2) waiting longer for the admission; 3) older patients.
DESIGN: Retrospective observational study.
POPULATION: 1000 randomly selected patients admitted between 2012 and 2016 to a day- rehabilitation center (DRC).
SETTING: University DRC specialized in musculoskeletal diseases.
METHODS: On admission all cases underwent clinical verification of RD. Inappropriateness regarding primary diagnoses and comorbidities were noted. Influence of several factors affecting probability of inaccurate RD was analyzed with multiple binary regression model applied to 6 categories of diseases.
RESULTS AND DISCUSSION: The rate of inaccurate RD was 25.2%. Higher frequency of inaccurate RD was noted among patients referred by non-PRM specialists (30.3% vs 17.3% in cases referred by PRM specialists). Application of logit regression showed highly significant influence of the specialty of a referring physician on the odds of inaccurate RD (joint Wald test ch2(6)=38.98, p- value=0.000), controlling for the influence of other variables. This may reflect a suboptimal knowledge of the rehabilitation process and a tendency to neglect of comorbidities by non-PRM specialists. The rate of inaccurate RD did not correlate with time between referral and admission (joint Wald test of all odds ratios equal to 1, chi2(6)=5.62, p-value=0.467), however, mean and median waiting times were relatively short (35.7 and 25 days respectively).A high risk of overlooked multimorbidity was revealed in elderly patients (all odds ratios for variable age significantly higher than 1). Hypotheses 1 and 3 were confirmed.
CONCLUSIONS: Over 25% of patients referred to DRC had inaccurate RD. Risk factors for inaccurate RD include referral by a non-PRM specialist and elderly age.
CLINICAL REHABILITATION IMPACT: Verification of RD should be routinely introduced to PRM practice.

KEY WORDS: Physical and rehabilitation medicine - Diagnosis - Diagnostic error

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Publication History

Article first published online: July 17, 2017
Manuscript accepted: July 14, 2017
Manuscript revised: June 30, 2017
Manuscript received: February 6, 2017

Cite this article as

Tederko P, Krasuski M, Nyka I, Mycielski J, Tarnacka B. Are patients referred to rehabilitation diagnosed accurately?. Eur J Phys Rehabil Med 2017 Jul 17. DOI: 10.23736/S1973-9087.17.04689-5

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