PURPOSE: To assess the impact of cross-sectional imaging with magnetic resonance (MR) imaging or computed tomography (CT) on clinical decision making for patients with lower back pain (LBP). MATERIALS AND METHODS: A randomized controlled before-and-after study was performed in 145 patients who had symptomatic lumbar spinal disorders and had been referred to orthopedists or neurosurgeons. Participants were a subgroup within a multicenter pragmatic randomized comparison of two imaging policies on LBP treatment: "imaging" versus "no imaging," unless a clear indication developed. Paired assessments were made of diagnosis, diagnostic confidence, proposed treatment, treatment confidence at trial entry and follow-up, and expectations of imaging. Data were analyzed according to the groups as randomized. RESULTS: At follow-up, there were no statistically significant differences between the groups with respect to diagnosis or treatment plans. Significant increases in diagnostic and therapeutic confidence between trial entry and follow-up were observed for both groups, with a significantly greater increase in diagnostic confidence (P =.01) in the imaging group. CONCLUSION: Imaging may increase diagnostic confidence but has minimal influence on diagnostic or therapeutic decisions for patients with LBP. The results highlight the need for evidence-based guidelines for imaging in LBP treatment.
RCT Entities:
PURPOSE: To assess the impact of cross-sectional imaging with magnetic resonance (MR) imaging or computed tomography (CT) on clinical decision making for patients with lower back pain (LBP). MATERIALS AND METHODS: A randomized controlled before-and-after study was performed in 145 patients who had symptomatic lumbar spinal disorders and had been referred to orthopedists or neurosurgeons. Participants were a subgroup within a multicenter pragmatic randomized comparison of two imaging policies on LBP treatment: "imaging" versus "no imaging," unless a clear indication developed. Paired assessments were made of diagnosis, diagnostic confidence, proposed treatment, treatment confidence at trial entry and follow-up, and expectations of imaging. Data were analyzed according to the groups as randomized. RESULTS: At follow-up, there were no statistically significant differences between the groups with respect to diagnosis or treatment plans. Significant increases in diagnostic and therapeutic confidence between trial entry and follow-up were observed for both groups, with a significantly greater increase in diagnostic confidence (P =.01) in the imaging group. CONCLUSION: Imaging may increase diagnostic confidence but has minimal influence on diagnostic or therapeutic decisions for patients with LBP. The results highlight the need for evidence-based guidelines for imaging in LBP treatment.
Authors: E Arana; F M Kovacs; A Royuela; A Estremera; H Sarasíbar; G Amengual; I Galarraga; C Martínez; A Muriel; V Abraira; J Zamora; C Campillo Journal: AJNR Am J Neuroradiol Date: 2011-04-14 Impact factor: 3.825
Authors: Fernando J Mota de Almeida; Sisko Huumonen; Anders Molander; Anders Öhman; Thomas Kvist Journal: Dentomaxillofac Radiol Date: 2016-03-17 Impact factor: 2.419
Authors: Stein J Janssen; Hugo H Hermanussen; Thierry G Guitton; Michel P J van den Bekerom; Derek F P van Deurzen; David Ring Journal: Clin Orthop Relat Res Date: 2016-01-21 Impact factor: 4.176
Authors: Elizabeth Molony; Andrew O Westfall; Brian A Perry; Rodney Tucker; Christine Ritchie; Michael Saag; Michael Mugavero; Joseph C Sullivan; Jessica S Merlin Journal: Pain Med Date: 2013-09-13 Impact factor: 3.750
Authors: Lukas P Staub; Sarah J Lord; R John Simes; Suzanne Dyer; Nehmat Houssami; Robert Y M Chen; Les Irwig Journal: BMC Med Res Methodol Date: 2012-02-14 Impact factor: 4.615