TY - JOUR
T1 - Appropriate use of diagnostic imaging in low back pain
T2 - A reminder that unnecessary imaging may do as much harm as good
AU - Flynn, Timothy W.
AU - Smith, Britt
AU - Chou, Roger
PY - 2011/11
Y1 - 2011/11
N2 - The rate of lumbar spine magnetic resonance imaging in the United States is growing at an alarming rate, despite evidence that it is not accompanied by improved patient outcomes. Overutilization of lumbar imaging in individuals with low back pain correlates with, and likely contributes to, a 2-to 3-fold increase in surgical rates over the last 10 years. Furthermore, a patient's knowledge of imaging abnormalities can actually decrease self-perception of health and may lead to fear-avoidance and catastrophizing behaviors that may predispose people to chronicity. The purpose of this clinical commentary is as follows: (1) to describe an outline of the appropriate use, as defined in recent guidelines, of diagnostic imaging in patients with low back pain; (2) to describe how inappropriate use of lumbar spine imaging can increase the risk of patient harm and contributes to the recent large increases in healthcare costs; (3) to provide physical therapists with clear guidelines to educate patients on both appropriate imaging and information to dampen the potential negative effects of imaging on patients' perceptions and health; and (4) to present an example of a successful clinical pathway that has reduced imaging and improved outcomes.
AB - The rate of lumbar spine magnetic resonance imaging in the United States is growing at an alarming rate, despite evidence that it is not accompanied by improved patient outcomes. Overutilization of lumbar imaging in individuals with low back pain correlates with, and likely contributes to, a 2-to 3-fold increase in surgical rates over the last 10 years. Furthermore, a patient's knowledge of imaging abnormalities can actually decrease self-perception of health and may lead to fear-avoidance and catastrophizing behaviors that may predispose people to chronicity. The purpose of this clinical commentary is as follows: (1) to describe an outline of the appropriate use, as defined in recent guidelines, of diagnostic imaging in patients with low back pain; (2) to describe how inappropriate use of lumbar spine imaging can increase the risk of patient harm and contributes to the recent large increases in healthcare costs; (3) to provide physical therapists with clear guidelines to educate patients on both appropriate imaging and information to dampen the potential negative effects of imaging on patients' perceptions and health; and (4) to present an example of a successful clinical pathway that has reduced imaging and improved outcomes.
KW - Lumbar spine
KW - MRI
KW - Magnetic resonance imaging
KW - Overutilization
KW - Prognosis
KW - Screening
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U2 - 10.2519/jospt.2011.3618
DO - 10.2519/jospt.2011.3618
M3 - Review article
C2 - 21642763
AN - SCOPUS:80655135605
SN - 0190-6011
VL - 41
SP - 838
EP - 846
JO - Journal of Orthopaedic and Sports Physical Therapy
JF - Journal of Orthopaedic and Sports Physical Therapy
IS - 11
ER -