Why does the adverse effect of inappropriate MRI for LBP vary by geographic location? An exploratory analysis

Abstract

BackgroundEarly magnetic resonance imaging (eMRI) for nonspecific low back pain (LBP) not adherent to clinical guidelines is linked with prolonged work disability. Although the prevalence of eMRI for occupational LBP varies substantially among states, it is unknown whether the risk of prolonged disability associated with eMRI varies according to individual and area-level characteristics. The aim was to explore whether the known risk of increased length of disability (LOD) associated with eMRI scanning not adherent to guidelines for occupational LBP varies according to patient and area-level characteristics, and the potential reasons for any observed variations.MethodsA retrospective cohort of 59,360 LBP cases from 49 states, filed between 2002 and 2008, and examined LOD as the outcome. LBP cases with at least 1 day of work disability were identified by reviewing indemnity service records and medical bills using a comprehensive list of codes from the International Classification of Diseases, Ninth Edition (ICD-9) indicating LBP or nonspecific back pain, excluding medically complicated cases.ResultsWe found significant between-state variations in the negative impact of eMRI on LOD ranging from 3.4 days in Tennessee to 14.8 days in New Hampshire. Higher negative impact of eMRI on LOD was mainly associated with female gender, state workers’ compensation (WC) policy not limiting initial treating provider choice, higher state orthopedic surgeon density, and lower state MRI facility density.ConclusionState WC policies regulating selection of healthcare provider and structural factors affecting quality of medical care modify the impact of eMRI not adherent to guidelines. Targeted healthcare and work disability prevention interventions may improve work disability outcomes in patients with occupational LBP.

Regional differences in time off work after injury: a comparison of Australian states and territories within a single workers’ compensation system

“…However, this leaves unanswered the question of which system features actually influence disability duration, and which of those are most important. There is a body of research linking a number of system features to disability duration including experience of the claims process and delays in claim processing, 44,45 fee schedules, healthcare provider choice, retroactive periods, 46,47 and rate of compensation. 42,48,49 However, modifications such as legislative change must be carefully considered as they may not work as intended, and in some cases may even have unintended negative consequences.…”

The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis

“…The main outcome was the measure of association between eMRI and LOD whether it was reported as odds ratios, relative risk, or mean difference in LOD between the eMRI group and the no eMRI group. The LOD was defined as the number of disability days (absence from work) due to the current episode of LBP [7,[11][12][13].…”

“…1) [10,[29][30][31][32][33][34][35][36]. Three reports (Shraim et al, 2015(Shraim et al, , 2017(Shraim et al, , and 2019) [6,7,13] used the same sample at the same time in the same settings but addressing different objectives. Therefore, a total of 7 studies were included in the quality assessment stage of this systematic review (Fig.…”

“…Therefore, a total of 7 studies were included in the quality assessment stage of this systematic review (Fig. 1) [6,7,[10][11][12][13]37].…”

“…All included studies were conducted in the United States (US) and used workers' compensation (WC) administrative databases. Six studies used a retrospective cohort study design [6,7,[11][12][13]37], and one study used a prospective cohort study design [10]. Three studies by Shraim and colleagues [6,7,13] used the same sample to examine the relationship between different individual-level variables (including eMRI) with neighborhood and state-level variables and LOD in LBP cases (see Table 3 for list of variables included in each study).…”