It is time to stop causing harm with inappropriate imaging for low back pain

Darlow, Ben; Forster, Bruce B.; O’Sullivan, Kieran; O’Sullivan, Peter

doi:10.1136/bjsports-2016-096741

Cited by 44 publications

(28 citation statements)

References 9 publications

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“…12 This can promote poorer health outcomes through misguided patient or clinician concern, 81 82 medicalisation of pain, 83 or through unfounded confidence that incidental findings on imaging are the cause of LBP. 82 84 85 The implication is that high levels of non-indicated imaging may contribute to the disease burden of LBP, 1 iatrogenic disease, and perpetuate low value care. [86][87][88] Unanswered questions and future research…”

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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“…In a previous editorial,2 we discussed the negative effects of inappropriate imaging such as subsequent additional downstream testing, additional imaging, invasive diagnostic procedures and unwarranted patient fear and anxiety leading to poorer outcomes, with concomitant cost and radiation exposure.…”

mentioning

confidence: 99%

Red flags or red herrings? Redefining the role of red flags in low back pain to reduce overimaging

et al. 2017

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“…This finding warrants further research aiming to design specific strategies and interventions to reduce unnecessary diagnostic imaging in the Brazilian health system. We would recommend further studies to understand the clinical-decision reasoning and aspects that might explain the overuse of diagnostic imaging for LBP in Brazil [45,49], to improve evidence-based decision support [50].…”

Section: Discussionmentioning

confidence: 99%

Low back pain should be considered a health and research priority in Brazil: Lost productivity and healthcare costs between 2012 to 2016

et al. 2020

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Background Low Back Pain (LBP) is associated with an increase in disability-adjusted life years, and increased risk of disability retirement and greater absenteeism in Brazil. Hence, evidence on healthcare and lost productivity costs due to LBP is of utmost importance to inform decision-makers. Methods Cost-of-illness study with top-down approach, and societal perspective. We extracted data from National databases, considering the period 2012-2016. Outpatient expenses included clinical, surgical, diagnosis, orthosis/prosthetics, and complementary actions. Inpatient care expenses included hospital and professional services, intensive care unit, and companion stay. For productivity losses, duration of work absence and associated information (workrelated and non-work-related; value of the sickness absence benefit; age; gender; and economic activity) were analyzed. Lost productivity costs were calculated multiplying the absence from work (days) by the daily-benefit. Results The societal costs amounted to US$ 2.2 billion, and productivity losses represented 79% of the costs. Total healthcare expenses were estimated to US$ 460 million. We found more than 880,000 diagnostic images. Individuals with LBP were in total 59 million days absent from work between 2012-2016. The mean lost days absent from work per person, for each

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It is time to stop causing harm with inappropriate imaging for low back pain

Cited by 44 publications

References 9 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

Red flags or red herrings? Redefining the role of red flags in low back pain to reduce overimaging

Low back pain should be considered a health and research priority in Brazil: Lost productivity and healthcare costs between 2012 to 2016

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