Article

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: 3.68). 06/2008; 29(6):1098-103. DOI: 10.3174/ajnr.A0999
Source: PubMed

ABSTRACT 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.

0 Followers
 · 
82 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Psoriasis is a chronic inflammatory disorder affecting 3% of the population. The objective of our study was to provide prevalence estimates for inflammatory back pain (IBP) and spondyloarthritis (SpA) in those subjects with psoriasis using 2009-2010 NHANES data.Methods In the NHANES 2009-2010 sample set, 6,684 persons between 20-69 years of age were screened for participation and 5,103 answered questions regarding onset of back pain, location of pain and functional limitations. Dataset assembly and statistical analysis were performed using SASTM and SUDAAN™. Standard errors were estimated by Taylor series linearization. The equality of the prevalence estimates for selected variables were tested (univariately) at the α=0.05 level using a 2-sided Student's t statistic with appropriate degrees of freedom.Results148 persons had self-reported medically diagnosed psoriasis. The psoriasis group, versus the non-psoriasis group, had a significantly higher prevalence of axial pain using the 3-month duration criterion (31.1% vs. 18.9%; p=0.04) and alternating buttock pain (7.2% vs. 2.4%; p=0.03) and met IBP criteria – Berlin 7b and 8a – more frequently (p=0.04, 0.02 respectively). The prevalence of SpA was significantly higher in the psoriasis group versus the non-psoriasis group when using Amor or ESSG criteria (14.3% vs. 1.5%; p<0.001). Sudden-onset of axial pain was significantly higher in the psoriasis group (23.3% vs. 13.0%; p=0.01).Conclusion There is a higher prevalence of lower axial pain, IBP, SpA, and alternating buttock pain associated with a prior diagnosis of psoriasis. This data may influence the way psoriasis patients are approached in primary care and specialty clinics. This article is protected by copyright. All rights reserved.
    11/2014; DOI:10.1002/acr.22528
  • BMJ Clinical Research 07/2014; 349:g4266. DOI:10.1136/bmj.g4266 · 14.09 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Initial management decisions following a new episode of low back pain (LBP) are thought to have profound implications for health care utilization and costs. The purpose of this study was to evaluate the impact of early and guideline adherent physical therapy for low back pain on utilization and costs within the Military Health System (MHS). Patients presenting to a primary care setting with a new complaint of LBP from January 1, 2007 to December 31, 2009 were identified from the MHS Management Analysis and Reporting Tool. Descriptive statistics, utilization, and costs were examined on the basis of timing of referral to physical therapy and adherence to practice guidelines over a 2-year period. Utilization outcomes (advanced imaging, lumbar injections or surgery, and opioid use) were compared using adjusted odds ratios with 99% confidence intervals. Total LBP-related health care costs over the 2-year follow-up were compared using linear regression models. 753,450 eligible patients with a primary care visit for LBP between 18-60 years of age were considered. Physical therapy was utilized by 16.3% (n = 122,723) of patients, with 24.0% (n = 17,175) of those receiving early physical therapy that was adherent to recommendations for active treatment. Early referral to guideline adherent physical therapy was associated with significantly lower utilization for all outcomes and 60% lower total LBP-related costs. The potential for cost savings in the MHS from early guideline adherent physical therapy may be substantial. These results also extend the findings from similar studies in civilian settings by demonstrating an association between early guideline adherent care and utilization and costs in a single payer health system. Future research is necessary to examine which patients with LBP benefit early physical therapy and determine strategies for providing early guideline adherent care.
    BMC Health Services Research 04/2015; 15(1). DOI:10.1186/s12913-015-0830-3 · 1.66 Impact Factor

Full-text (2 Sources)

Download
0 Downloads
Available from
Apr 6, 2015