Degenerative Cervical Myelopathy Awareness in Primary Care: UK National Cross-Sectional Survey of General Practitioners (Preprint)

Abstract

BACKGROUND Degenerative cervical myelopathy (DCM) is a progressive neurological condition, characterised by spinal cord injury secondary to degenerative changes in the spine. Misdiagnosis in primary care forms part of a complex picture leading to an average diagnostic delay of 2 years. This leads to potentially preventable and permanent disability. A lack of awareness secondary to deficits in postgraduate educational may contribute to these delays. OBJECTIVE The aim of this study was to assess the awareness of DCM in the setting of general practice. METHODS General practitioners (GPs) completed a quantitative web-based cross-sectional questionnaire. The 17-item questionnaire captured data regarding demographics, subjective awareness, and objective knowledge. The questionnaire was disseminated via professional networks, including via practice managers and senior practice partners. Incentivisation was provided via a bespoke DCM fact sheet for those that completed the survey. RESULTS A total of 54 GPs representing all 4 UK nations responded to the survey. GPs most commonly self-assessed that they had ‘Limited Awareness’ of DCM (n=24, 51.1%). GPs felt most commonly ‘Moderately Able’ to recognise a case of DCM (n=21, 45.65%). In total 13.0% (n=6) of respondents reported that they would not be at all able to recognise a patient with DCM. Respondents most commonly reported that they were ‘Moderately Confident’ in their ability to triage a patient with DCM (n=19, 41.30%). A quarter of respondents reported no prior introduction to DCM throughout their medical training (n=13, 24.53%). The mean score for knowledge-based questions was 42.6 ± 3.96 % with the lowest performance observed in patient demographic and clinical recognition items. CONCLUSIONS GPs lack confidence in the recognition and management of DCM. These findings are consistent with the diagnostic delays previously described in the literature at the primary care level. Further work to develop and implement educational interventions to GP practices is a crucial step to improving patient outcomes in DCM.