Imaging rates and appropriateness for patients with low back pain as ordered by primary care physicians

Logan, Gabrielle S. (2019) Imaging rates and appropriateness for patients with low back pain as ordered by primary care physicians. Masters thesis, Memorial University of Newfoundland.

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Abstract

Choosing Wisely recommends reducing unnecessary radiological imaging for low back pain. This thesis explored imaging appropriateness for low back pain compared to these recommendations in Newfoundland and Labrador and globally. A minor part included a descriptive study to provide age-sex standardised rates of lumbar spine Computed Tomography in the Eastern Health Region. The main thesis portion focused on imaging appropriateness and included two main studies; a systematic review and meta-analysis of lumbar spine x-ray and CT appropriateness, and a medical record review of lumbar spine CT referrals. The systematic review and meta-analysis, conducted using the PRISMA statement, found that 44% of x-rays and 54% of CTs were appropriate. The medical record review conducted in 2016 in Eastern Health included 3,595 lumbar spine CTs referrals. It found 5.5% were appropriate, 75.8% were potentially appropriate, and 16.8% were inappropriate. Unnecessary imaging occurs despite guidelines advising against them. Future research to understand why physicians order imaging for back pain patients and effective reduction interventions are necessary.

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