Effects of Diagnostic Information, Per Se, on Patient Outcomes in Acute Radiculopathy and Low Back Pain

Division of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
American Journal of Neuroradiology (Impact Factor: 3.59). 06/2008; 29(6):1098-103. DOI: 10.3174/ajnr.A0999
Source: PubMed


We conducted a prospective randomized study of patients with acute low back pain and/or radiculopathy to assess the effect of knowledge of diagnostic findings on clinical outcome. The practice of ordering spinal imaging, perhaps unintentionally, includes a large number of patients for whom the imaging test is performed for purposes of reassurance or because of patient expectations. If this rationale is valid, one would expect to see a measurable effect from diagnostic information, per se.
A total of 246 patients with acute (<3 weeks) low back pain (LBP) and/or radiculopathy (150 LBP and 96 radiculopathy patients) were recruited. Patients were randomized using a stratified block design with equal allocation to either the unblinded group (MR imaging results provided within 48 hours) or the blinded group (both patient and physician blinded to MR imaging results.) After the initial MR imaging, patients followed 6 weeks of conservative management. Roland function, visual pain analog, absenteeism, Short Form (SF)-36 Health Status Survey, self-efficacy scores, and Fear Avoidance Questionnaire were completed at presentation; 2, 4, 6, and 8 weeks; and 6, 12, and 24 months. Improvement of Roland score by 50% or more and patient satisfaction assessed by Cherkin symptom satisfaction measure were considered a positive outcome.
Clinical outcome at 6 weeks was similar for unblinded and blinded patients. Self-efficacy, fear avoidance beliefs, and the SF-36 subscales were similar over time for blinded and unblinded patients, except for the general health subscale on the SF-36. General health of the blinded group improved more than for the unblinded group (P = .008).
Patient knowledge of imaging findings do not alter outcome and are associated with a lesser sense of well-being.

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Available from: Paul N Grooff, Apr 06, 2015
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    • "MRI can detect lumbosacral disc herniation (the most common cause of lumbosacral radiculopathy), and indeed it provides superior image quality for spine and intervertebral discs compared to computed tomography (CT). Nonetheless, MRI is more expensive than CT, and some researchers also have found that MRI has limitations with respect to the diagnosis of low back pain or radiculopathy [3-5]. Tellingly, a considerable number of patients and even asymptomatic subjects have been misdiagnosed with disc herniation by MRI [6,7]. "
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    Annals of Rehabilitation Medicine 06/2013; 37(3):355-63. DOI:10.5535/arm.2013.37.3.355
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    • "Given that the term 'non-specific LBP' most likely refers to many LBP problems with different etiologies, ensuring 'the right patient gets the right treatment at the right time' is a particular challenge. While imaging seems a logical way to resolve this dilemma, the use of early magnetic resonance imaging (MRI) scans does not alter patients' outcomes and are actually associated with persistent perceptions of poor health [22]. "
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