Understanding patient beliefs regarding the use of imaging in the management of low back pain

Jenkins, Hazel; Hancock, Mark J.; Maher, Christopher G.; French, Simon; Magnussen, John

doi:10.1002/ejp.764

Cited by 62 publications

(60 citation statements)

References 22 publications

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“…The drivers of excessive imaging are multifactorial and incorporate many aspects of the health system including sluggish imaging guideline reform, 89 reliance on individual red flags that offer little or no diagnostic value when a patient is triaged toward further investigations including imaging, 90 91 regional variation (eg, different interpretations of legislation), 44 cultural practices (eg, patient/practitioner beliefs), 92 or financial interest (eg, clinicians with financial interest in MRI scanners). 93 The majority of studies in our review either did not explore drivers of excessive imaging, or focused on a single issue such as health insurer variation 36 or effect of clinical decision support.…”

Section: Meaning Of the Study: Possible Explanations And Implicationsmentioning

confidence: 99%

How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years

et al. 2019

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word count: 304 Manuscript word count: 3392 2 ABSTRACT Objectives: To (i) estimate the proportion of patients seeking care for low back pain (LBP) who are imaged, and (ii) explore trends in the proportion of patients who received diagnostic imaging over time. We also examined the effect of study-level factors on estimates of imaging proportion. Eligibility criteria for selecting studies: Observational designs and controlled trials that reported imaging for patients presenting to primary care or emergency care for LBP. We assessed study quality and calculated pooled proportions by care setting and imaging type, with strength of evidence assessed using the GRADE system. Results: 45 studies were included. They represented 19,451,749 consultations for low back pain that had resulted in 4,343,919 imaging requests/events over 21 years. Primary care: moderate quality evidence that simple imaging proportion was 16.3% (95%CI 12.6 to 21.1) and complex imaging was 9.2% (95%CI 6.2 to 13.5). For any imaging the pooled proportion was 24.8% (95%CI 19.3 to 31.1). Emergency care: moderate quality evidence that simple imaging proportion was 26.1% (95%CI 18.2 to 35.8) and high quality evidence that complex imaging proportion was 8.2% (95%CI 4.4 to 15.6). For any imaging the pooled proportion was 35.6 % (95%CI 29.8 to 41.8). Complex imaging increased from 7.4% (95%CI 5.7 to 9.6) forimaging requested in 1995, to 11.4% (95%CI 9.6 to 13.5) in 2015 (relative increase of 53.5%).Between-study variability in imaging proportions was only partially explained by study-level characteristics; there were insufficient data to comment on some pre-specified study-level factors.Summary/conclusion: One in 4 patients who presented to primary care with low back pain received imaging as did one in 3 who presented to the Emergency department. The rate of

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Section: Meaning Of the Study: Possible Explanations And Implicationsmentioning

confidence: 99%

How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years

et al. 2019

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“…Many patients expect imaging for their LBP and worry that they have a serious condition 15. It is important that clinicians take time to listen to patients’ concerns and explain why the patient does not need imaging.…”

Section: First-line Carementioning

confidence: 99%

“…This may involve informing patients of the evidence that scan findings (eg, disc degeneration) are common in people with and without pain, and imaging will not lead to better outcomes 16–18. As well as this, clinicians should explain the reasons for the encouragement to avoid bed rest and remain active, even when in pain 15. This message is important to relay as rest was once the mainstay treatment for LBP.…”

Section: First-line Carementioning

confidence: 99%

Non-pharmacological treatment of low back pain in primary care

O’Keeffe

2019

DTB

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“…Проведение рентгенографии, КТ или МРТ у пациентов со скелетно-мышечной ПБ не улучшает прогноз заболевания, не влияет на развитие осложнений и хронизацию процесса, при этом неоправданно увеличиваются стоимость обследования, обеспокоенность пациента и частота хирургических вмешательств [45]. Важно объяснить пациенту отсутствие необходимости в выполнении этих исследований [46].…”

Section: о б с л е д о в а н и еunclassified

Acute nonspecific (musculoskeletal) low back pain Guidelines of the Russian Society for the Study of Pain (RSSP)

Parfenov¹,

Yakhno²,

Кукушкин³

et al. 2018

RJTAO

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7 620028, Екатеринбург, ул. Репина, 3 У пациента с острой поясничной болью (ПБ) проводят оценку жалоб и данных анамнеза, краткое соматическое и неврологическое обследование, определяют наличие симптомов опасности. Диагноз острой неспецифической (скелетно-мышечной) ПБ основывается на исключении специфической причины боли (потенциально опасного заболевания), дискогенной радикулопатии и поясничного стеноза. В случаях типичной скелетно-мышечной боли, отсутствия симптомов опасности не рекомендуются проведение рентгенографии, рентгеновской компьютерной томографии, магнитно-резонансной томографии в первые 4 нед заболевания. Целесообразность их выполнения рассматривается при сохранении ПБ сверх этого времени. Пациент с острой неспецифической (скелетно-мышечной) ПБ должен быть проинформирован о благоприятном исходе заболевания, необходимости сохранять физическую и социальную активность, избегать постельного режима, при возможности продолжать профессиональную деятельность. Для облегчения боли можно использовать нестероидные противовоспалительные препараты в минимально эффективных дозах и коротким курсом, а также миорелаксанты (средний уровень доказательности). Части пациентов целесообразно назначить мануальную терапию и массаж спины (низкий уровень доказательности). Для предупреждения рецидивов ПБ рекомендуются образовательная программа (профилактика чрезмерных нагрузок, длительного пребывания в статических и неудобных позах, правильные способы подъема тяжестей и др.) и вне периода обострения -лечебная гимнастика. Ключевые слова: острая неспецифическая (скелетно-мышечная) поясничная боль; рекомендации по диагностике, лечению и профилактике. Контакты: Вероника Александровна Головачева; xoxo.veronicka@gmail.com Для ссылки: Парфенов ВА, Яхно НН, Кукушкин МЛ и др. Острая неспецифическая (скелетно-мышечная) поясничная боль. Рекомендации Российского общества по изучению боли (РОИБ). Неврология, нейропсихиатрия, психосоматика. 2018;10(2):4-11. Acute nonspecific (musculoskeletal) low back pain Guidelines of the Russian Society for the Study of Pain (RSSP)

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Understanding patient beliefs regarding the use of imaging in the management of low back pain

Cited by 62 publications

References 22 publications

How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years

How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years

Non-pharmacological treatment of low back pain in primary care

Acute nonspecific (musculoskeletal) low back pain Guidelines of the Russian Society for the Study of Pain (RSSP)

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