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Musculoskeletal and Sports Medicine

(Research Hub Theater) Diagnostic Agreement for Patients Evaluated with Hip or Ankle Pain to Plan Extracorporeal Shockwave Therapy

Thursday, November 16, 2023
12:45 PM – 2:15 PM CT
Background and/or Objectives: An appropriate clinical diagnosis is a key factor in the planning of procedures. Extracorporeal shockwave therapy (ESWT) is a unique procedure that through the principle of clinical focusing uses the painful feedback response to guide treatment and identify the primary diagnosis. A recent retrospective study found similar diagnostic agreement for patients evaluated in-person compared to telehealth prior to ESWT. The purpose of this study is to understand whether the primary location of condition treated affects diagnostic agreement. We hypothesized that diagnosis agreement will be higher for the ankle compared to the hip, given the challenges in isolating pain in the hip region.

Design: Retrospective Chart Review

Setting: Sports Medicine Clinic

Participants: 158 patients evaluated for ESWT for either hip (n=61) or ankle (n=97) pain.

Interventions: Not applicable.

Main Outcome Measures: Diagnostic agreement for patients with hip compared to ankle pain, as defined by congruency between primary diagnosis reached using telehealth or in-person visit to primary diagnosis from procedure visit with ESWT.

Results: Diagnostic agreement was higher for those patients presenting with ankle pain compared to hip pain (96% vs 87%, Χ2 = 4.31, p = 0.038). Logistic regression of patients presenting with hip pain did not identify any significant predictors of diagnostic agreement including type of visit (telehealth or in-person) or imaging at time of planning procedure.

Conclusions: Diagnostic agreement was lower for patients presenting with hip pain compared to ankle pain when performing ESWT. One advantage of ESWT is that clinical focusing based on the painful feedback response allows adjustment in the targeted treatment and further informs the clinical diagnosis. Providers should consider alternative diagnosis for primary source of hip pain and use clinical focusing when performing ESWT.