Implementation and evaluation of existing guidelines on the use of neurophysiological tests in non-acute migraine patients: a questionnaire survey of neurologists and primary care physicians.
Rossi, P.; Schoenen, Jean; Bolla, M.et al.
2009 • In European Journal of Neurology, 16 (8), p. 937-42
[en] BACKGROUND AND PURPOSE: The main aims of this study were to evaluate: the diffusion, use and perception of the usefulness of the 2004 EFNS guidelines on neurophysiological testing in non-acute headache patients; the frequency with which the different neurophysiological tests were recommended in non-acute migraine patients by physicians aware or unaware of the guidelines; and the appropriateness of the reasons given for recommending neurophysiological tests. METHODS: One hundred and fifty physicians selected amongst the members of the Italian societies of general practitioner (GPs), neurologists and headache specialists were contacted via e-mail and invited to fill in a questionnaire specially created for the study. RESULTS: Ninety-two percent of the headache specialists, 8.6% of the neurologists and 0% of the GPs were already aware of the EFNS guidelines. A significantly higher proportion of headache specialists had not recommended any neurophysiological tests to the migraine patients they had seen in the previous 3 months, whereas these tests had frequently been prescribed by the GPs and neurologists. Overall, 80%, 42% and 42.6% of the reasons given by headache specialists, neurologists and GPs, respectively, for recommending neurophysiological testing in their migraine patients were appropriate (P < 0.01). CONCLUSIONS: The diffusion of the EFNS guidelines on neurophysiological tests and neuroimaging procedures was found to be very limited amongst neurologists and GPs. The physicians aware of the EFNS guidelines recommended neurophysiological tests to migraine patients less frequently and more appropriately than physicians who were not aware of them. The most frequent misconceptions regarding neurophysiological tests concerned their perceived capacity to discriminate between migraine and secondary headaches or between migraine and other primary headaches.
Disciplines :
Neurology
Author, co-author :
Rossi, P.
Schoenen, Jean ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Neuro-anatomie
Bolla, M.
Tassorelli, C.
Sandrini, G.
Nappi, G.
Language :
English
Title :
Implementation and evaluation of existing guidelines on the use of neurophysiological tests in non-acute migraine patients: a questionnaire survey of neurologists and primary care physicians.
Campbell JK, Sakai F. The Migraines. Diagnosis and differential diagnosis. In : Olesen J, Tfelt-Hansen P, Welch KMA eds. The Headaches, 2nd edn. Philadelphia : Lippincott Williams & Wilkins, 2000 : 359 363.
Nappi G, Jensen R, Nappi RE, Sances G, Torelli P, Olesen J. Diaries and calendars for migraine. A review. Cephalalgia 2006 26 : 905 916.
Tassorelli C, Sances G, Allena M, et al. The usefulness and applicability of a basic headache diary before first consultation: results of a pilot study conducted in two centres. Cephalalgia. 2008 28 : 1023 1030. [Epub ahead of print, Jul 8]
Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM. Does this patient with headache have a migraine or need neuroimaging? JAMA 2006 296 : 1274 1283.
Schoenen J, Sándor PS. Headache with focal neurological signs or symptoms: a complicated differential diagnosis. Lancet Neurol. 2004 3 : 237 245.
Evans RW. Diagnostic testing for headache. Med Clin North Am 2001 85 : 865 885.
Nappi G, Rossi P. Migraine: symptomatology and diagnostic issues. In : Nappi G, Rossi P, eds. Migraine: Current Concepts. London : Current Medical Literature, 2004 : 89 90.
Sandrini G, Friberg L, Janig W, et al. Neurophysiological tests and neuroimaging procedures in non-acute headache: guidelines and recommendations. Eur J Neurol 2004 11 : 217 224.
Oxman AD, Fretheim A, Schunemann HJ. Improving the use of research evidence in guideline development: introduction. Health Res Policy Syst 2006 4 : 12.
Burgers JS, Grol R, Klazings NS, Makela M, Zaat J. Toward evidence-based clinical practice: an international survey of 18 clinical guideline programs. Int J Qual Health Care 2003 15 : 31 45. (Pubitemid 36305560)
Francke AL, Smit MC, de Veer AJ, Mistiaen P. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak 2008 8 : 38.
Solberg LI. Guideline implementation: what the literature doesn't tell us. Jt Comm J Qual Improv 2000 26 : 526 536.
Martelletti P, Haimanot RT, Láinez MJ, et al. The global campaign (GC) to reduce the burden of headache worldwide. The International Team for Specialist Education (ITSE). J Headache Pain 2005 6 : 261 263.