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Positive straight-leg raising in lumbar radiculopathy: is documentation affected by insurance coverage?
Scott F Nadler1, Gerard A Malanga, Donald S Ciccone
1Departments of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103-2499, USA. sfnadler@cs.com
Objective:
To evaluate whether differences exist in documentation of straight-leg raising (SLR), based on insurance coverage.
Design:
Retrospective study.
Setting:
Managed care organization (MCO).
Participants:
Two hundred people with a diagnosis of lumbar radiculopathy or herniated disk were referred to an MCO for authorization of further treatment. Half were self-directed under a personal injury program (PIP) after automobile collisions, and half were covered under a managed care workmen's compensation (WC) program.
Interventions:
Not applicable.
Main Outcome Measures:
Documentation of an SLR test, strength, sensation, and/or reflexes were eligible for the study. The results of SLR were coded as 0, 1, or 2, for absent, positive unilateral, and positive bilateral, respectively. Additional information included subject age, sex, date of injury, provider type, and presence of attorney representation
Results:
A positive (unilateral, bilateral) SLR in women was 7.4 times more likely if they were covered by PIP than by WC (95% confidence interval [CI], 1.4-38.7; P=.018). For men, a positive SLR was 23.5 times more likely if they were covered by a PIP (95% CI, 2.9-189.9; P=.003). The odds of bilateral SLR (radicular pain on both sides) were even more strongly associated with type of reimbursement. For women, bilateral SLR was 105.1 times more likely if they were covered by a PIP than by WC (95% CI, 11.1-992.6; P<.001). For men, bilateral SLR was 38.9 times more likely if covered by a PIP (95% CI, 11.3-133.6; P<.001).
Conclusions:
Reasons for reporting higher rates of positive SLR in the PIP group include an added incentive to treat, poor knowledge of proper interpretation of the SLR test, and/or an increased exaggeration of symptoms.
