Prevalence of positive neural findings in patients attending outpatient physical therapy: an exploratory study

Neurological testing is commonly used in outpatient physical therapy (PT) for patients with suspected neurological involvement. However, limited data exist on the prevalence of abnormal neurological findings in patients without a peripheral neuropathic pain (PNP) diagnosis. Understanding the frequency of these findings may help refine screening practices and improve patient care. This study aimed to determine the prevalence of abnormal neurological findings in patients attending PT without a clinical PNP diagnosis.

This observational study included 104 adult patients attending PT for upper or lower quadrant pain. Each patient underwent a series of clinical neurologic tests (strength, sensation, and reflexes) and neurodynamic (ND) tests. Patients were categorized as having either a clinical PNP diagnosis or a non-PNP diagnosis based on physician and/or physical therapist assessment.

Of the participants, 22% had a clinical PNP diagnosis. Among those without a PNP diagnosis, clinical neurologic test abnormalities were common, with 50.6% exhibiting abnormal reflexes, 48.1% showing strength deficits, and 21% having sensory impairments. ND test abnormalities were less frequent in this group, with 18.5% experiencing symptom reproduction during testing.

These findings suggest that abnormal neurological test results are not exclusive to patients with a clinical PNP diagnosis. The high prevalence of clinical neurologic test abnormalities in patients without a PNP diagnosis raises questions about the sensitivity of current screening approaches.

Neurological abnormalities may be overlooked when screening is based solely on clinical diagnosis or reported symptoms. Expanding neurological testing to a broader patient population may enhance diagnostic accuracy and treatment planning. Further research is needed to determine the clinical significance of these findings and the potential benefits of routine neurological screening in outpatient PT.