Presenting Symptoms Define Time to Diagnosis in Degenerative Cervical Myelopathy: Process Mapping From a Musculoskeletal Triage Unit in the UK

Foulds, Stephanie; Henshaw, Lorraine; Davies, Benjamin M.

Abstract

Study Design: Retrospective cohort study.

Objective: Tackling delayed diagnosis in degenerative cervical myelopathy (DCM) is a global research priority. On average, it takes 2–5 years, leading to worse outcomes from surgery and greater disability. Many countries in the UK use interface triage units run by specialist physiotherapists that sit between primary and secondary care termed musculoskeletal services. Their rolein the efficient diagnosis of DCM is unknown. The aim of this study was to map the journey of the patient in the musculo-skeletal service and to establish the presenting signs and symptoms.

Methods: A retrospective review of 2.5 years of clinical notes was performed in a musculoskeletal service. Process mapping wasutilised to visualise the patient's journey and identify delays to diagnosis and presenting signs and symptoms.

Results: Twenty‐seven cases were reviewed. Patients spent an average of three months in the service. There was a wide varietyof presenting symptoms. DCM was more often suspected if patients had both upper limb symptoms and gait disturbance orpathological reflexes. Delays occurred when patients had no gait disturbance or a normal or incomplete neurological assessment. Longest delays occurred when patients received electrophysiology tests for differential diagnosis of peripheral neuropathies. Delays were also seen with incorrect triaging of MRI results.

Conclusions: Where DCM is the principal differential diagnosis, diagnosis was faster. Incomplete examination, misinterpre-tation of MRI findings or delays in other investigations contributed to delays. Improved awareness and protocols of care within musculoskeletal services represent an opportunity to accelerate diagnosis in DC

Citation

Foulds, S., Henshaw, L., & Davies, B. M. (2025). Presenting Symptoms Define Time to Diagnosis in Degenerative Cervical Myelopathy: Process Mapping From a Musculoskeletal Triage Unit in the UK. Musculoskeletal Care, 23(1), Article e70044. https://doi.org/10.1002/msc.70044

• Journal Article Type: Article
• Acceptance Date: Dec 18, 2024
• Online Publication Date: Jan 9, 2025
• Publication Date: 2025-03
• Deposit Date: Jan 10, 2025
• Journal: Musculoskeletal Care
• Print ISSN: 1478-2189
• Electronic ISSN: 1557-0681
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 23
• Issue: 1
• Article Number: e70044
• DOI: https://doi.org/10.1002/msc.70044
• Additional Information: Received: 2024-12-12; Accepted: 2024-12-23; Published: 2025-01-09