Referrals to the specialist health service for patients with neck or back pain

National guidelines recommend that patients with neck or back pain who show no signs of improvement after 4-6 weeks be referred to the specialist health service. The referral should include details of medical history, clinical examination and treatment. Limited use of diagnostic imaging is recommended for neck and back pain with no red flags. The aim of the study was to assess the quality of referrals from primary care to the specialist health service for neck and back pain.

We reviewed 632 referrals to the Neck and Back Outpatient Clinic at the Department of Physical Medicine and Rehabilitation, Oslo University Hospital, and recorded information on medical history, clinical examination and supplementary investigations. Factors that predict whether a referral was accepted or rejected were identified using regression analysis.

Of the 632 referrals assessed, 524 (83 %) included a medical history with pain anamnesis, 360 (57 %) contained information on clinical examination and 573 (91 %) included MRI findings. The referrals lacked information on current medication use, treatment and employment status in 166 (26 %), 244 (39 %) and 199 (31 %) cases, respectively. Information on medical history, employment status and clinical examination was the strongest predictor of referral acceptance.

The results suggest that about half of patients with neck and back pain undergo a clinical examination before referral to the specialist health service, while nearly all have an MRI scan. Approximately one-third of the referrals were considered to be of low quality, which complicated the assessment of eligibility for specialist evaluation.