A Survey of Primary Care Physician Practice Patterns and Adherence to Acute Low Back Problem Guidelines

Iorio, Daniel Di; Henley, Eric; Doughty, Andrea

doi:10.1001/archfami.9.10.1015

Cited by 153 publications

(103 citation statements)

References 19 publications

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“…3,8,10,20 The correlation between lumbar spine MRI findings and clinical symptoms and signs is poor. 19 The prevalence of irrelevant imaging "abnormalities" is so high that unnecessary imaging might actually be harmful if it leads to unnecessary tests, surgery, patient anxiety, dependence, or fear/avoidance behavior.…”

Section: Discussionmentioning

confidence: 99%

Spine surgery referrals redirected through a multidisciplinary care pathway: effects of nonsurgeon triage including MRI utilization

Kindrachuk¹,

Fourney²

2014

SPI

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Object The Saskatchewan Spine Pathway (SSP) was introduced to improve quality and access to care for patients with low-back and leg pain in the province. There is very limited data regarding the efficacy of nonsurgeon triage of surgical referrals. The objective of this early implementation study was to determine how the SSP affects utilization of MRI and spine surgery. Methods The authors performed a retrospective analysis of 87 consecutive patients with low-back and leg pain who were initially referred to a spine surgeon but were instead redirected to the SSP clinic between May 1, 2011, and November 30, 2011. The SSP clinic triaged patients into 2 groups: Group A (nonsurgical management) and Group B (referred back to the spine surgeon). The SSP classification was modified from the classification proposed by Hall et al. Pain and disability were scored by pain-related visual analog scale, modified Oswestry Disability Index, and EuroQol-5D. Results Sixty-two patients (Group A, 71.3%) were discharged after patient education, self-care advice, and/or referral for additional mechanical therapies. Although only 25 patients (Group B, 28.7%) were directed back to the surgeon, the final percentage (12.6%) offered surgery was similar to that of historic controls (15%). Total MRI utilization was significantly lower in Group A (25.8%) than Group B (92.0%) (p < 0.0001). Nonsurgeon triage captured all red flags detected by the surgeon. Patients in Group B were much more likely to have a leg-dominant pain (p = 0.0088) and had significantly higher Oswestry Disability Index (p = 0.0121) and EuroQol-5D mobility (p = 0.0484) scores. Conclusions The SSP significantly reduced MRI utilization and referrals seen by the surgeon for nonoperative care. Although this early implementation study suggests potential for cost savings, a more rigorous analysis of outcomes, costs, and patient satisfaction is required.

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Section: Discussionmentioning

confidence: 99%

Spine surgery referrals redirected through a multidisciplinary care pathway: effects of nonsurgeon triage including MRI utilization

Kindrachuk¹,

Fourney²

2014

SPI

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“…This statement appears both logical and obvious; however, data suggest that in the current US healthcare system this is clearly not the guiding principle. 22,42 A recent study in the Journal of the American College of Radiology found that 26% of medical images ordered were inappropriate, and the authors cited "MR for acute back pain without conservative therapy" as a criterion for identifying inappropriate utilization. 41 The study found a 53% inappropriate referral rate for CT and 35% inappropriate referral rate for MRI.…”

Section: Inappropriate Use Of Lumbar Spine Imaging: Harmful Effects Dmentioning

confidence: 99%

Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good

Flynn

Smith²,

Chou³

2011

J Orthop Sports Phys Ther

126

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“…These results may serve as a benchmark for faculty to assess existing curricula, allow for further development of imaging curricula, and provide a benchmark for the profession regarding current level of training for recent graduates of entry-level physical therapist professional degree programs. J Orthop Sports Phys Ther 2014;44(8):579-586. doi:10.2519/ jospt.2014 11,12,17,22,26,30 Since the mid 1990s, this overutilization has been associated with disproportionate increases in health care costs. 17,20 Boyles et al 7 raised the question of whether physical therapists are adequately educated regarding appropriate imaging referral.…”

mentioning

confidence: 99%

Diagnostic and Procedural Imaging Curricula in Physical Therapist Professional Degree Programs

Boissonnault¹,

White²,

Carney³

et al. 2014

J Orthop Sports Phys Ther

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While the integration of diagnostic and procedural imaging (eg, plain-film radiography/radiographs, magnetic resonance imaging [MRI], computed tomography [CT], scintigraphy [bone scan], and ultrasonography) in US military physical therapist practice has an extensive history, 14,16 the role of imaging in care provided by physical therapists in civilian sectors is largely unknown. Few published examples describe civilian-sector practice models that include physical therapists referring patients directly for imaging tests, 7 and a recent summary of physical therapy practice act language for the 50 states and the District of Columbia regarding the role of imaging revealed tremendous variability. The language ranged from "prohibiting the use of roentgen rays for any purpose" (physical therapists cannot turn the X-ray machine on) to prohibiting physical therapists from referring patients for diagnostic imaging to being "silent" on the issue. 7 The continued effort to pass "patient direct access to physical therapy services" (referred to as first-contact practice) legislation has fueled discussions on physical therapists' abilities (or lack of ) to refer patients directly to radiologists for diagnostic imaging. To enhance efficiency of health care delivery, and for health care consumers to maximally benefit from first contact with physical therapists, the ability to directly refer patients to other providers, including radiologists, would seem paramount. 7,13 Inherent to this ability is the responsibility of appropriate patient referral for diagnostic imaging. Despite clinical guidelines directing appropriate ordering of imaging modalities T T STUDY DESIGN: Descriptive survey. T T OBJECTIVE:To describe the status of diagnostic and procedural imaging curricula within United States physical therapist professional degree programs. T T BACKGROUND:As patient direct access to physical therapy services increases, the ability to refer patients directly for diagnostic imaging could promote more efficient delivery of care. Appropriate patient referral is contingent on physical therapists having the requisite knowledge base and skills. While evidence describing imaging competence of physical therapists with advanced training in military institutions exists, evidence is lacking for other physical therapists, including new graduates of physical therapist professional degree programs. T T METHODS: Faculty members teaching imagingat 206 United States physical therapist professional degree programs recognized by the Commission on Accreditation in Physical Therapy Education were recruited via e-mail correspondence. An e-mail attachment included the survey on which faculty reported imaging curricula and faculty qualifications, attitudes, and experiences. T T RESULTS:Faculty from 155 (75.2%) programs responded to the survey, with imaging being included in the curriculum of 152 programs. Content was integrated by required standalone courses or clinical science track courses, and/or through elective courses. The average reported estimate o...

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A Survey of Primary Care Physician Practice Patterns and Adherence to Acute Low Back Problem Guidelines

Cited by 153 publications

References 19 publications

Spine surgery referrals redirected through a multidisciplinary care pathway: effects of nonsurgeon triage including MRI utilization

Spine surgery referrals redirected through a multidisciplinary care pathway: effects of nonsurgeon triage including MRI utilization

Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good

Diagnostic and Procedural Imaging Curricula in Physical Therapist Professional Degree Programs

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