J L Witherow1, H J Jenkins2, J M Elliott3,4, G H Ip2, C G Maher5,6, J S Magnussen2, M J Hancock2. 1. From the Faculty of Medicine, Health and Human Sciences (J.L.W., H.J.J., G.H.I., J.S.M., M.J.H), Macquarie University, Sydney, New South Wales, Australia jess.witherow@gmail.com. 2. From the Faculty of Medicine, Health and Human Sciences (J.L.W., H.J.J., G.H.I., J.S.M., M.J.H), Macquarie University, Sydney, New South Wales, Australia. 3. Faculty of Medicine and Health (J.M.E.). 4. The Kolling Institute of Medical Research (J.M.E.), Northern Sydney Local Health District, Sydney, New South Wales, Australia. 5. Sydney School of Public Health (C.G.M.), Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia. 6. Institute for Musculoskeletal Health (C.G.M.), Sydney, New South Wales, Australia.
Abstract
BACKGROUND: Patients and clinicians may misinterpret the clinical importance of imaging findings in patients with low back pain, leading to potential harm related to overdiagnosis. PURPOSE: Our aims were to qualitatively summarize the characteristics of tested interventions that target the reporting, communication, or clinical interpretation of lumbar imaging findings and determine whether interventions are effective in improving low back pain-related health outcomes, health care use, or health care costs. DATA SOURCES: PubMed, MEDLINE, CINAHL, EMBASE, PsycINFO, and the Cochrane Library were searched from inception to October 20, 2021. STUDY SELECTION: The search retrieved 4394 articles, nine articles (seven studies) met the inclusion criteria to summarize intervention characteristics. Five of these studies had an adequate design for evaluating intervention effectiveness. DATA ANALYSES: Intervention characteristics were summarized using the Template for Intervention Description and Replication checklist. Effectiveness data were extracted from short, intermediate, and long-term follow-up points. Studies were assessed for risk of bias, and Grading of Recommendations Assessment, Development and Evaluation methodology was used to determine the certainty of the evidence. DATA SYNTHESIS: Four studies investigated the insertion of prevalence information into imaging reports. Single studies investigated withholding diagnostic information, education, and reassurance. Moderate-quality evidence (from 1 study) suggests that inserting prevalence information into imaging reports probably does not change the overall health care use in the long-term but may reduce opioid prescribing. LIMITATIONS: The available evidence is limited, and a meta-analysis was not possible. CONCLUSIONS: Further work is required to develop and test interventions that target the reporting, communication, and clinical interpretation of lumbar imaging findings that may reduce overdiagnosis and improve the management of low back pain.
BACKGROUND: Patients and clinicians may misinterpret the clinical importance of imaging findings in patients with low back pain, leading to potential harm related to overdiagnosis. PURPOSE: Our aims were to qualitatively summarize the characteristics of tested interventions that target the reporting, communication, or clinical interpretation of lumbar imaging findings and determine whether interventions are effective in improving low back pain-related health outcomes, health care use, or health care costs. DATA SOURCES: PubMed, MEDLINE, CINAHL, EMBASE, PsycINFO, and the Cochrane Library were searched from inception to October 20, 2021. STUDY SELECTION: The search retrieved 4394 articles, nine articles (seven studies) met the inclusion criteria to summarize intervention characteristics. Five of these studies had an adequate design for evaluating intervention effectiveness. DATA ANALYSES: Intervention characteristics were summarized using the Template for Intervention Description and Replication checklist. Effectiveness data were extracted from short, intermediate, and long-term follow-up points. Studies were assessed for risk of bias, and Grading of Recommendations Assessment, Development and Evaluation methodology was used to determine the certainty of the evidence. DATA SYNTHESIS: Four studies investigated the insertion of prevalence information into imaging reports. Single studies investigated withholding diagnostic information, education, and reassurance. Moderate-quality evidence (from 1 study) suggests that inserting prevalence information into imaging reports probably does not change the overall health care use in the long-term but may reduce opioid prescribing. LIMITATIONS: The available evidence is limited, and a meta-analysis was not possible. CONCLUSIONS: Further work is required to develop and test interventions that target the reporting, communication, and clinical interpretation of lumbar imaging findings that may reduce overdiagnosis and improve the management of low back pain.
Authors: Jonathan A C Sterne; Jelena Savović; Matthew J Page; Roy G Elbers; Natalie S Blencowe; Isabelle Boutron; Christopher J Cates; Hung-Yuan Cheng; Mark S Corbett; Sandra M Eldridge; Jonathan R Emberson; Miguel A Hernán; Sally Hopewell; Asbjørn Hróbjartsson; Daniela R Junqueira; Peter Jüni; Jamie J Kirkham; Toby Lasserson; Tianjing Li; Alexandra McAleenan; Barnaby C Reeves; Sasha Shepperd; Ian Shrier; Lesley A Stewart; Kate Tilling; Ian R White; Penny F Whiting; Julian P T Higgins Journal: BMJ Date: 2019-08-28
Authors: Pradeep Suri; Eric N Meier; Laura S Gold; Zachary A Marcum; Sandra K Johnston; Kathryn T James; Brian W Bresnahan; Michael O'Reilly; Judith A Turner; David F Kallmes; Karen J Sherman; Richard A Deyo; Patrick H Luetmer; Andrew L Avins; Brent Griffith; Patrick J Heagerty; Sean D Rundell; Jeffrey G Jarvik; Janna L Friedly Journal: Pain Med Date: 2021-06-04 Impact factor: 3.750
Authors: Jeffrey G Jarvik; Eric N Meier; Kathryn T James; Laura S Gold; Katherine W Tan; Larry G Kessler; Pradeep Suri; David F Kallmes; Daniel C Cherkin; Richard A Deyo; Karen J Sherman; Safwan S Halabi; Bryan A Comstock; Patrick H Luetmer; Andrew L Avins; Sean D Rundell; Brent Griffith; Janna L Friedly; Danielle C Lavallee; Kari A Stephens; Judith A Turner; Brian W Bresnahan; Patrick J Heagerty Journal: JAMA Netw Open Date: 2020-09-01
Authors: Christoph Alexander Stueckle; Sarah Talarczyk; Kerstin Frauke Stueckle; Christian Beisenherz; Patrick Haage Journal: Z Gerontol Geriatr Date: 2021-06-11 Impact factor: 1.292