Jeffrey G Jarvik1, Laura S Gold2, Bryan A Comstock3, Patrick J Heagerty3, Sean D Rundell4, Judith A Turner5, Andrew L Avins6, Zoya Bauer7, Brian W Bresnahan7, Janna L Friedly4, Kathryn James8, Larry Kessler9, Srdjan S Nedeljkovic10, David R Nerenz11, Xu Shi12, Sean D Sullivan13, Leighton Chan14, Jason M Schwalb15, Richard A Deyo16. 1. Department of Radiology, University of Washington, Seattle2Department of Neurological Surgery, University of Washington, Seattle3Department of Health Services, University of Washington, Seattle4Comparative Effectiveness, Cost and Outcomes Research Center. 2. Department of Radiology, University of Washington, Seattle4Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle11Department of Pharmacy, University of Washington, Seattle. 3. Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle5Department of Biostatistics, University of Washington, Seattle. 4. Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle7Department of Rehabilitation Medicine, University of Washington, Seattle. 5. Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle6Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle. 6. Division of Research, Northern California Kaiser to Permanente, Oakland. 7. Department of Radiology, University of Washington, Seattle4Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle. 8. Department of Radiology, University of Washington, Seattle. 9. Department of Health Services, University of Washington, Seattle. 10. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Spine Unit, Harvard Vanguard Medical Associates, Boston, Massacusetts. 11. Neuroscience Institute, Henry Ford Hospital, Detroit, Michigan. 12. Department of Biostatistics, University of Washington, Seattle. 13. Department of Pharmacy, University of Washington, Seattle. 14. Rehabilitation Medicine Department, Mark O. Hatfield Clinical Research Center, National Institutes of Health, Bethesda, Maryland. 15. Department of Neurosurgery and the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. 16. Department of Family Medicine, Internal Medicine, and Public Health and Preventive Medicine, and the Oregon Institute for Occupational Health Sciences, Oregon Health and Science University, Portland.
Abstract
IMPORTANCE: In contrast to the recommendations for younger adults, many guidelines allow for older adults with back pain to undergo imaging without waiting 4 to 6 weeks. However, early imaging may precipitate interventions that do not improve outcomes. OBJECTIVE: To compare function and pain at the 12-month follow-up visit among older adults who received early imaging with those who did not receive early imaging after a new primary care visit for back pain without radiculopathy. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort of 5239 patients 65 years or older with a new primary care visit for back pain (2011-2013) in 3 US health care systems. We matched controls 1:1 using propensity score matching of demographic and clinical characteristics, including diagnosis, pain severity, pain duration, functional status, and prior resource use. EXPOSURES: Diagnostic imaging (plain films, computed tomography [CT], magnetic resonance imaging [MRI]) of the lumbar or thoracic spine within 6 weeks of the index visit. PRIMARY OUTCOME: back or leg pain-related disability measured by the modified Roland-Morris Disability Questionnaire (score range, 0-24; higher scores indicate greater disability) 12 months after enrollment. RESULTS: Among the 5239 patients, 1174 had early radiographs and 349 had early MRI/CT. At 12 months, neither the early radiograph group nor the early MRI/CT group differed significantly from controls on the disability questionnaire. The mean score for patients who underwent early radiography was 8.54 vs 8.74 among the control group (difference, -0.10 [95% CI, -0.71 to 0.50]; mixed model, P = .36). The mean score for the early MRI/CT group was 9.81 vs 10.50 for the control group (difference,-0.51 [-1.62 to 0.60]; mixed model, P = .18). CONCLUSIONS AND RELEVANCE: Among older adults with a new primary care visit for back pain, early imaging was not associated with better 1-year outcomes. The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain.
IMPORTANCE: In contrast to the recommendations for younger adults, many guidelines allow for older adults with back pain to undergo imaging without waiting 4 to 6 weeks. However, early imaging may precipitate interventions that do not improve outcomes. OBJECTIVE: To compare function and pain at the 12-month follow-up visit among older adults who received early imaging with those who did not receive early imaging after a new primary care visit for back pain without radiculopathy. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort of 5239 patients 65 years or older with a new primary care visit for back pain (2011-2013) in 3 US health care systems. We matched controls 1:1 using propensity score matching of demographic and clinical characteristics, including diagnosis, pain severity, pain duration, functional status, and prior resource use. EXPOSURES: Diagnostic imaging (plain films, computed tomography [CT], magnetic resonance imaging [MRI]) of the lumbar or thoracic spine within 6 weeks of the index visit. PRIMARY OUTCOME: back or leg pain-related disability measured by the modified Roland-Morris Disability Questionnaire (score range, 0-24; higher scores indicate greater disability) 12 months after enrollment. RESULTS: Among the 5239 patients, 1174 had early radiographs and 349 had early MRI/CT. At 12 months, neither the early radiograph group nor the early MRI/CT group differed significantly from controls on the disability questionnaire. The mean score for patients who underwent early radiography was 8.54 vs 8.74 among the control group (difference, -0.10 [95% CI, -0.71 to 0.50]; mixed model, P = .36). The mean score for the early MRI/CT group was 9.81 vs 10.50 for the control group (difference,-0.51 [-1.62 to 0.60]; mixed model, P = .18). CONCLUSIONS AND RELEVANCE: Among older adults with a new primary care visit for back pain, early imaging was not associated with better 1-year outcomes. The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain.