Driving the Musculoskeletal Diagnosis Train on the High-Value Track

J Orthop Sports Phys Ther. 2020 Mar;50(3):118-120. doi: 10.2519/jospt.2020.0603.


Clinicians who provide high-value musculoskeletal care offer evidence-based management that can improve pain, function, and quality of life. However, the current approach to improving outcomes emphasizes treatment strategies at the expense of accurate diagnosis. Guidelines rarely provide quality information on differential diagnosis and prognosis. The disconnect is worrying, because accurate diagnosis can lead to more appropriate care and improved patient outcomes. In this Viewpoint, we reflect on how the clinician can refine musculoskeletal diagnoses to provide high-value care. We (1) argue that the link between musculoskeletal diagnosis and patient outcomes must be strengthened, (2) introduce a diagnostic framework to help clinicians go beyond "special tests," and (3) present new methods for researchers to move forward from diagnostic accuracy studies. J Orthop Sports Phys Ther 2020;50(3):118-120. doi:10.2519/jospt.2020.0603.

Keywords: clinical practice; diagnosis; outcomes.

MeSH terms

  • Clinical Decision-Making
  • Humans
  • Low Back Pain / diagnosis
  • Low Back Pain / etiology
  • Low Back Pain / therapy
  • Musculoskeletal Diseases / diagnosis*
  • Musculoskeletal Diseases / therapy*
  • Musculoskeletal Pain / diagnosis
  • Musculoskeletal Pain / etiology
  • Musculoskeletal Pain / therapy
  • Patellofemoral Pain Syndrome / diagnosis
  • Patellofemoral Pain Syndrome / etiology
  • Patellofemoral Pain Syndrome / therapy
  • Patient Outcome Assessment*
  • Quality of Health Care*
  • Randomized Controlled Trials as Topic