Effectiveness of interventions designed to reduce the use of imaging for low-back pain: A systematic review

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Rates of imaging for low-back pain are high and are associated with increased health care costs and radiation exposure as well as potentially poorer patient outcomes. We conducted a systematic review to investigate the effectiveness of interventions aimed at reducing the use of imaging for low-back pain. Methods: We searched MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials from the earliest records to June 23, 2014. We included randomized controlled trials, controlled clinical trials and interrupted time series studies that assessed interventions designed to reduce the use of imaging in any clinical setting, including primary, emergency and specialist care. Two independent reviewers extracted data and assessed risk of bias. We used raw data on imaging rates to calculate summary statistics. Study heterogeneity prevented meta-analysis. Results: A total of 8500 records were identified through the literature search. Of the 54 potentially eligible studies reviewed in full, 7 were included in our review. Clinical decision support involving a modified referral form in a hospital setting reduced imaging by 36.8% (95% confidence interval [CI] 33.2% to 40.5%). Targeted reminders to primary care physicians of appropriate indications for imaging reduced referrals for imaging by 22.5% (95% CI 8.4% to 36.8%). Interventions that used practitioner audits and feedback, practitioner education or guideline dissemination did not significantly reduce imaging rates. Lack of power within some of the included studies resulted in lack of statistical significance despite potentially clinically important effects. Interpretation: Clinical decision support in a hospital setting and targeted reminders to primary care doctors were effective interventions in reducing the use of imaging for low-back pain. These are potentially low-cost interventions that would substantially decrease medical expenditures associated with the management of low-back pain.

LanguageEnglish
Pages401-408
Number of pages8
JournalCMAJ
Volume187
Issue number6
DOIs
Publication statusPublished - 7 Apr 2015

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Low Back Pain
Clinical Decision Support Systems
Referral and Consultation
Confidence Intervals
Controlled Clinical Trials
Primary Care Physicians
Emergency Medical Services
Health Expenditures
MEDLINE
Health Care Costs
Meta-Analysis
Primary Health Care
Randomized Controlled Trials
Guidelines
Education
Costs and Cost Analysis

Cite this

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title = "Effectiveness of interventions designed to reduce the use of imaging for low-back pain: A systematic review",
abstract = "Background: Rates of imaging for low-back pain are high and are associated with increased health care costs and radiation exposure as well as potentially poorer patient outcomes. We conducted a systematic review to investigate the effectiveness of interventions aimed at reducing the use of imaging for low-back pain. Methods: We searched MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials from the earliest records to June 23, 2014. We included randomized controlled trials, controlled clinical trials and interrupted time series studies that assessed interventions designed to reduce the use of imaging in any clinical setting, including primary, emergency and specialist care. Two independent reviewers extracted data and assessed risk of bias. We used raw data on imaging rates to calculate summary statistics. Study heterogeneity prevented meta-analysis. Results: A total of 8500 records were identified through the literature search. Of the 54 potentially eligible studies reviewed in full, 7 were included in our review. Clinical decision support involving a modified referral form in a hospital setting reduced imaging by 36.8{\%} (95{\%} confidence interval [CI] 33.2{\%} to 40.5{\%}). Targeted reminders to primary care physicians of appropriate indications for imaging reduced referrals for imaging by 22.5{\%} (95{\%} CI 8.4{\%} to 36.8{\%}). Interventions that used practitioner audits and feedback, practitioner education or guideline dissemination did not significantly reduce imaging rates. Lack of power within some of the included studies resulted in lack of statistical significance despite potentially clinically important effects. Interpretation: Clinical decision support in a hospital setting and targeted reminders to primary care doctors were effective interventions in reducing the use of imaging for low-back pain. These are potentially low-cost interventions that would substantially decrease medical expenditures associated with the management of low-back pain.",
author = "Jenkins, {Hazel J.} and Hancock, {Mark J.} and French, {Simon D.} and Maher, {Chris G.} and Engel, {Roger M.} and Magnussen, {John S.}",
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Effectiveness of interventions designed to reduce the use of imaging for low-back pain : A systematic review. / Jenkins, Hazel J.; Hancock, Mark J.; French, Simon D.; Maher, Chris G.; Engel, Roger M.; Magnussen, John S.

In: CMAJ, Vol. 187, No. 6, 07.04.2015, p. 401-408.

Research output: Contribution to journalArticleResearchpeer-review

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