Degenerative cervical myelopathy is the most common cause of spinal cord impairment internationally and estimated to affect 5% of adults over the age of 40 years. Unfortunately, it is thought to be significantly underdiagnosed due to the lack of condition awareness and highly non-specific presentations and disease trajectory. The present survey aimed to establish the current level of condition awareness and screening confidence amongst primary healthcare clinicians in New Zealand.
Methods:
Cross-sectional, electronic survey methodology was employed to collect responses on perceived awareness, confidence and DCM understanding from primary healthcare clinicians in NZ, including: general medical practitioners (GP), nurse practitioners (NP), physiotherapists, chiropractors and osteopaths. Upon review of the literature, a 12-question survey was developed and modified upon piloting it. Ethics approval was granted by the Auckland University of Technology Ethics Committee (23/113) and descriptive analytics were utilised to review survey data.
Results:
255 clinicians responded to the survey. Of these, 28% were GPs, 44% physiotherapists, 16% chiropractors, 12% nurse practitioners and 2% osteopaths. Respondents had an average of 14.5 years of clinical experience (SD=8.52). Our findings revealed that only 20% reported that they had a high level of awareness of DCM and only 16% were confident to screen for the condition. Notably, 54% indicated a lack of prior education of DCM. GPs were less likely to have had prior education when compared to physiotherapists and chiropractors (p=0.05) and unsurprisingly, had lower levels of awareness and confidence in screening for DCM (p=0.05).
Amongst clinicians with higher levels of screening confidence, the following percentages of respondents recognised specific symptoms as characteristic of DCM: upper limb pain/paraesthesia (96.5%), neck pain and stiffness (91.9%), hand dexterity decline (87.3%), and gait disturbance (74%). There was less consistency in regard to characteristic signs of DCM, with 65.9% of respondents selecting tandem gait disturbance, 61.9% selected patient age > 45 years, 57.2% selected Babinski sign and 49.7% selected Hoffmans sign. Importantly, the majority of respondents (88%) indicated that they were interested in receiving further education about DCM.
Conclusion
Even in this diverse group of primary healthcare clinicians with significant clinical experience, this study has demonstrated relatively low levels of both awareness and ability to screen for DCM. Of those that reported higher levels of confidence, we have shown that there is no clear agreement in regard to which signs and symptoms have the most diagnostic value. These findings suggest that this condition may well be under-diagnosed and that a delayed diagnosis is likely for many patients. Unfortunately, both scenarios impact the outcome for DCM sufferers due to the known progressive nature of the condition, and educational strategies targeted to primary healthcare should be considered.