Patient’s perceptions of physical examination in the setting of chronic pain

Abstract

Introduction

Despite its clinical utility, progressive reliance on imaging technology can lead to devaluing the physical examination in patients with chronic pain. The primary objective of this study was to determine whether chronic pain patients have a positive or negative perception of the physical examination.

Methods

After institutional ethics committee approval, 120 adult patients as a convenience sample who attended a chronic pain clinic were included. Participants completed a 10-item survey regarding their overall perception of the physical examination. Kruskal-Wallis and Mann-Whitney U test analyses were conducted to explore associations between test items and patient ages, gender, employment, pain diagnosis, and duration of pain. All cross-tabulations of categorical variables were analyzed using Fisher’s exact test for associations.

Results

The majority of participants were male (51%), aged 50–70 (44%). The most common pain diagnosis was back pain (62%). Most patients (77%) indicated that the overall experience of being examined was highly positive. Patients believe in the value of the physical examination as a diagnostic tool (97%). Patients believe in the relational value of the physical examination (92%). Age, gender, employment, pain diagnosis, and duration of pain were not associated with a more positive perception of the physical examination.

Conclusion

Patients with chronic pain indicate that the physical examination is a highly positive aspect of their care. There are some negative aspects of been examined which physicians should be aware of. This study adds to our knowledge regarding the physical exam in chronic pain patients. It will inform practice and training.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Fitzgerald FT (1990) Physical diagnosis versus modern technology. A review. West J Med 152:377–382

    CAS  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Verghese A, Horwitz RI (2009) In praise of the physical examination [serial online]. BMJ 339:b5448

    Article  Google Scholar 

  3. 3.

    Oboler SK, Prochazka AV, Gonzales R et al (2002) Public expectations and attitudes for annual physical examinations and testing. Ann Intern Med 136:652–659

    Article  Google Scholar 

  4. 4.

    Kravitz RL, Cope DW, Bhrany V, Leake B (1994) Internal medicine patients’ expectations for care during office visits. J Gen Intern Med 9:75–81

    CAS  Article  Google Scholar 

  5. 5.

    Brody DS, Miller SM, Lerman CE et al (1989) The relationship between patients’ satisfaction with their physicians and perceptions about interventions they desired and received. Med Care 27:1027–1035

    CAS  Article  Google Scholar 

  6. 6.

    Kravitz RL, Bell RA, Azari R et al (2002) Request fulfillment in office practice: antecedents and relationship to outcomes. Med Care 40:38–51

    Article  Google Scholar 

  7. 7.

    Kravitz RL, Callahan EJ (2000) Patients’ perceptions of omitted examinations and tests: a qualitative analysis. J Gen Intern Med 15:38–45

    CAS  Article  Google Scholar 

  8. 8.

    Lillrank A (2003) Back pain and the resolution of diagnostic uncertainty in illness narratives. Soc Sci Med 57(6):1045–1054

    Article  Google Scholar 

  9. 9.

    Kenny DT (2004) Constructions of chronic pain in doctor-patient relationships: bridging the communication chasm. Patient Educ Couns 52(3):297–305

    Article  Google Scholar 

  10. 10.

    Crofford LJ (2015) Psychological aspects of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol 29(1):147–155

    Article  Google Scholar 

  11. 11.

    Atkinson S, Macnaughton J, Saunders C, Evans M (2010) Cool intimacies of care for contemporary clinical practice. Lancet 376:1732–1733

    Article  Google Scholar 

  12. 12.

    Pohl G, Seemann H, Zojer N et al (2007) “Laying on of hands” improves well-being in patients with advanced cancer. Support Care Cancer 15:143–151

    Article  Google Scholar 

  13. 13.

    Kadakia KC, Hui D, Chisholm GB et al (2014) Cancer patients' perceptions regarding the value of the physical examination: a survey study. Cancer 120(14):2215–2221

    Article  Google Scholar 

  14. 14.

    McNaughton DT, Hush JM, Beath AP et al (2018) No moderating impact of a medically unexplained etiology on the relationship between psychological profile and chronic pain. J Psychosom Res 115:87–93

    Article  Google Scholar 

  15. 15.

    Battalio SL, Glette M, Alschuler KN, Jensen MP (2018) Anxiety, depression, and function in individuals with chronic physical conditions: a longitudinal analysis. Rehabil Psychol 63(4):532–541

    Article  Google Scholar 

  16. 16.

    Elkiss ML, Jerome JA (2012) Touch—more than a basic science. J Am Osteopath Assoc 112:514–517

    PubMed  Google Scholar 

  17. 17.

    Howe CQ, Robinson JP, Sullivan MD (2015) Psychiatric and psychological perspectives on chronic pain. Phys Med Rehabil Clin N Am 26(2):283–300

    Article  Google Scholar 

  18. 18.

    Phillips LA, Carroll LJ, Voaklander DC et al (2012) Pain coping in injured workers with chronic pain: what’s unique about workers? Disabil Rehabil 34(21):1774–1782

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Dominic C. Harmon.

Ethics declarations

The Institutional Research and Ethics Committee of the University Hospitals Limerick, Ireland, approved all study procedures.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hashim, M.M., Edgeworth, D.M., Saunders, J.A. et al. Patient’s perceptions of physical examination in the setting of chronic pain. Ir J Med Sci 190, 313–316 (2021). https://doi.org/10.1007/s11845-020-02250-2

Download citation

Keywords

  • Chronic pain
  • Patient satisfaction
  • Physical examination