Low back pain: Can we mitigate the inadvertent psycho-behavioural harms of spinal imaging?

Wheeler, Luke P.; Karran, Emma L; Harvie, Daniel S.

doi:10.31128/ajgp-03-18-4525

Cited by 18 publications

(12 citation statements)

References 20 publications

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“…This reassurance related to patients receiving an explanation for the cause of their pain and feeling assured that there was no serious underlying pathology; what Pincus et al [28] classify as 'cognitive reassurance'. This finding contrasts with other literature, including arguments by Wheeler et al [29], that imaging patients with LBP can lead to distress if aberrant findings are identified. The reason for the difference in findings may be that in the case of non-specific LBP, often no obvious cause of pain is identified through scan results, leading patients to experience frustration and uncertainty towards unexplained symptoms [30].…”

Section: Discussioncontrasting

confidence: 99%

Patients’ and clinicians’ perspectives on a ‘fast-track’ pathway for patients with sciatica in primary care: qualitative findings from the SCOPiC stratified care trial

Saunders

Konstantinou

Artus

et al. 2020

BMC Musculoskelet Disord

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Background: Sciatica is common and associated with significant impacts for the individual and society. The SCOPiC randomised controlled trial (RCT) (trial registration: ISRCTN75449581) tested stratified primary care for sciatica by subgrouping patients into one of three groups based on prognostic and clinical indicators. Patients in one group were 'fast-tracked' for a magnetic resonance imaging (MRI) scan and spinal specialist opinion. This paper reports qualitative research exploring patients' and clinicians' perspectives on the acceptability of this 'fast-track' pathway. Methods: Semi-structured interviews were conducted with 20 patients and 20 clinicians (general practitioners, spinal specialist physiotherapists, spinal surgeons). Data were analysed thematically and findings explored using Normalisation Process Theory (NPT) and 'boundary objects' concept. Results: Whilst the 'fast-track' pathway achieved a degree of 'coherence' (i.e. made sense) to both patients and clinicians, particularly in relation to providing early reassurance based on MRI scan findings, it was less 'meaningful' to some clinicians for managing patients with acute symptoms, reflecting a reluctance to move away from the usual 'stepped care' approach. Both groups felt a key limitation of the pathway was that it did not shorten patient waiting times between their spinal specialist consultation and further treatments. Conclusion: Findings contribute new knowledge about patients' and clinicians' perspectives on the role of imaging and spinal specialist opinion in the management of sciatica, and provide important insights for understanding the 'fast-track' pathway, as part of the stratified care model tested in the RCT. Future research into the early referral of patients with sciatica for investigation and specialist opinion should include strategies to support clinician behaviour change; as well as take into account the role of imaging in providing reassurance to patients with severe symptoms in cases where imaging reveals a clear explanation for the patient's pain, and where this is accompanied by a thorough explanation from a trusted clinical expert.

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Section: Discussioncontrasting

confidence: 99%

Patients’ and clinicians’ perspectives on a ‘fast-track’ pathway for patients with sciatica in primary care: qualitative findings from the SCOPiC stratified care trial

Saunders

Konstantinou

Artus

et al. 2020

BMC Musculoskelet Disord

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“…Harm associated with opioid use22 and inappropriate use of imaging23 24 for LBP have been reported in previous reviews. Unwarranted hospital admission has received less attention but is arguably equally as important due to the consequent risk of wasting healthcare resources and exposing patients to extended but guideline-discordant care for LBP, such as continued opioid use.…”

Section: Discussionmentioning

confidence: 85%

Management of low back pain in Australian emergency departments for culturally and linguistically diverse populations from 2016 to 2021

et al. 2023

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BackgroundDisparate care in the ED for minority populations with low back pain is a long-standing issue reported in the USA. Our objective was to compare care delivery for low back pain in Australian EDs between culturally and linguistically diverse (CALD) and non-CALD patients.MethodsThis is a retrospective review of medical records of the ED of three public hospitals in Sydney, New South Wales, Australia from January 2016 to October 2021. We included adult patients diagnosed with non-serious low back pain at ED discharge. CALD status was defined by country of birth, preferred language and use of interpreter service. The main outcome measures were ambulance transport, lumbar imaging, opioid administration and hospital admission.ResultsOf the 14 642 included presentations, 7656 patients (52.7%) were born overseas, 3695 (25.2%) preferred communicating in a non-English language and 1224 (8.4%) required an interpreter. Patients born overseas were less likely to arrive by ambulance (adjusted OR (aOR) 0.68, 95% CI 0.63 to 0.73) than Australian-born patients. Patients who preferred a non-English language were also less likely to arrive by ambulance (aOR 0.82, 95% CI 0.75 to 0.90), yet more likely to be imaged (aOR 1.12, 95% CI 1.01 to 1.23) or be admitted to hospital (aOR 1.16, 95% CI 1.04 to 1.29) than Native-English-speaking patients. Patients who required an interpreter were more likely to receive imaging (aOR 1.43, 95% CI 1.25 to 1.64) or be admitted (aOR 1.49, 95% CI 1.29 to 1.73) compared with those who communicated independently. CALD patients were generally less likely to receive weak opioids than non-CALD patients (aOR range 0.76–0.87), yet no difference was found in the use of any opioid or strong opioids.ConclusionPatients with low back pain from a CALD background, especially those lacking English proficiency, are significantly more likely to be imaged and admitted in Australian EDs. Future interventions improving the quality of ED care for low back pain should give special consideration to CALD patients.

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“…38 However, it has been suggested that education to reassure patients of their normal age-related imaging ndings, and the inconsistent association between these ndings and pain will help combat the negative outcomes and still meet patient expectations. 41 Further research is required to better determine the role of appropriate reassurance compared to diagnostic imaging in achieving optimal patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Adherence to low back pain clinical guidelines in Australian hospital emergency departments: a public and private comparison

Samanna,

Buntine,

Belavy

et al. 2024

Preprint

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Background Low back pain (LBP) is the leading cause of disability worldwide. Managing LBP via clinical practice guidelines in healthcare settings is recommended, yet burgeoning evidence suggests adherence is suboptimal in the emergency department (ED) setting. Whether adherence differs between public and private settings is unknown. This study compared adherence to LBP clinical guidelines between a private and public Australian hospital ED. Methods A retrospective audit of 86 private patients were matched to 86 public patients by age (± 5 years), sex (male/female) and LBP duration (first time/history of LBP). Patient charts were reviewed according to the Australian clinical guidelines for the management of LBP. Guidelines were considered individually and via a collective guideline adherence score (GAS). Results Management GAS was lower in private patients compared to public patients (d [95%CI]: -0.67 [-0.98, -0.36], P < 0.001). Public patients were more likely to have documentation of guideline-based advice (OR [95%CI]: 4.4 [2.4, 8.4], P < 0.001) and less likely to be sent for imaging (OR [95%CI]: 5.0 [2.6, 9.4], P < 0.001). Private patients were more likely to have documented screening for psychosocial risk factors (OR [95%CI]: 21.8 [9.1, 52.1], P < 0.001) and more likely to receive guideline-based medication prescriptions at patient discharge (OR [95%CI]: 2.2 [1.2, 4.2], P = 0.013). Conclusion Findings suggest that differences exist in public and private hospital ED guideline adherence. Exploring barriers and facilitators underpinning differences in guideline implementation will assist in guiding future implementation science approaches.

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Low back pain: Can we mitigate the inadvertent psycho-behavioural harms of spinal imaging?

Cited by 18 publications

References 20 publications

Patients’ and clinicians’ perspectives on a ‘fast-track’ pathway for patients with sciatica in primary care: qualitative findings from the SCOPiC stratified care trial

Patients’ and clinicians’ perspectives on a ‘fast-track’ pathway for patients with sciatica in primary care: qualitative findings from the SCOPiC stratified care trial

Management of low back pain in Australian emergency departments for culturally and linguistically diverse populations from 2016 to 2021

Adherence to low back pain clinical guidelines in Australian hospital emergency departments: a public and private comparison

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