Symptom assessment in lumbar stenosis/spondylolysis - patient questionnaire versus physician chart.

Background: The precision of symptom assessment and documentation in daily routine is unknown. Differences in hip studies have been observed between the charts and the patient questionnaires. This was the reason to perform this study and to compare the charts and the patient questionnaires.

Methods: This was a retrospective study of physician versus patient symptom ratings in spondylolysis/spinal stenosis patients before and after lumbar spinal surgery. Symptoms were assessed just prior to surgery and 3 and 12 months after surgery, by patients using self-administered validated questionnaire (NASS lumbar element) and by physicians recording notes in patient charts. Presence or absence of symptoms was analysed for back/buttock pain, leg pain, and neurological signs. Agreement between patient and physician rating was scored as total (agreement in all 3 categories), partial (agreement in 1 or 2 categories) or none, at each time point.

Results: A total of 44 patients completed the study; average age was 63 years; 68% were women. Symptoms in all 3 symptom categories were reduced significantly 3 and 12 months after surgery, especially leg pain and neurological symptoms. Total agreement between patient and physician ratings of symptoms was substantially lower after surgery (22-28%) than before (50%). This was mainly attributable to physicians reporting less leg pain and neurological signs after surgery than patients. Total agreement was lower for older patients.

Conclusions: The agreement of main symptoms between the charts and the patient questionnaires seems to be low and may be ameliorated with more time and more structured interviews to ensure that the physician's patient chart more closely reflects the patient's self-rating, than was the case in this study.