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The impact of choosing words carefully: an online investigation into imaging reporting strategies and best practice care for low back pain
BACKGROUND: Low back pain clinical practice guidelines consistently recommend against the routine ordering of spinal imaging; however, imaging is frequently requested in primary care, without evidence of benefit. Imaging reports frequently identify degenerative features which are likely to be interp...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
PeerJ Inc.
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5723139/ https://www.ncbi.nlm.nih.gov/pubmed/29230375 http://dx.doi.org/10.7717/peerj.4151 |
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author | Karran, Emma L. Medalian, Yasmin Hillier, Susan L. Moseley, G. Lorimer |
author_facet | Karran, Emma L. Medalian, Yasmin Hillier, Susan L. Moseley, G. Lorimer |
author_sort | Karran, Emma L. |
collection | PubMed |
description | BACKGROUND: Low back pain clinical practice guidelines consistently recommend against the routine ordering of spinal imaging; however, imaging is frequently requested in primary care, without evidence of benefit. Imaging reports frequently identify degenerative features which are likely to be interpreted as ‘abnormal’, despite their high prevalence in symptom-free individuals. The aim of this study was to investigate whether post-imaging back-related perceptions are influenced by providing prior information about normal findings, and to compare the effect of receiving imaging results with best practice care (without imaging). The impact of introducing novel, ‘enhanced’ reporting strategies was also explored. METHODS: This study was a simulated-patient, randomised, multiple-arm experiment. Patient scenarios were presented to volunteer healthy adult participants via an online survey. In the scenarios, ‘virtual’ patients with low back pain were randomised to one of three groups. Group 1 received imaging and was pre-informed about normal findings. Group 2 received imaging (without pre-information). Group 3 received best practice care: quality information without imaging. Group 1 was further divided to receive either a standard report, or an ‘enhanced’ report (containing altered terminology and epidemiological information). The primary outcome was back-related perceptions (BRP), a composite score derived from three numeric rating scale scores exploring perceptions of spinal condition, recovery concerns and planned activity. The secondary outcomes were satisfaction and kinesiophobia. RESULTS: Full data were available from 660 participants (68% female). Analysis of covariance revealed a significant effect of group after controlling for baseline BRP scores [Image: see text] . Pairwise comparisons indicated that receiving best practice care resulted in more positive BRPs than receiving imaging results, and receiving prior information about normal findings had no impact. Enhanced reporting strategies also positively impacted BRPs [Image: see text] . Significant relationships between group allocation and both satisfaction [Image: see text] and kinaesiophobia [Image: see text] were found, with statistically significant pairwise comparisions again in favour of best-practice care. CONCLUSION: Intervention strategies such as enhanced reporting methods and the provision of quality information (without imaging) have the potential to improve the outcome of patients with recent-onset LBP and should be further considered by primary care providers. |
format | Online Article Text |
id | pubmed-5723139 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | PeerJ Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-57231392017-12-11 The impact of choosing words carefully: an online investigation into imaging reporting strategies and best practice care for low back pain Karran, Emma L. Medalian, Yasmin Hillier, Susan L. Moseley, G. Lorimer PeerJ Evidence Based Medicine BACKGROUND: Low back pain clinical practice guidelines consistently recommend against the routine ordering of spinal imaging; however, imaging is frequently requested in primary care, without evidence of benefit. Imaging reports frequently identify degenerative features which are likely to be interpreted as ‘abnormal’, despite their high prevalence in symptom-free individuals. The aim of this study was to investigate whether post-imaging back-related perceptions are influenced by providing prior information about normal findings, and to compare the effect of receiving imaging results with best practice care (without imaging). The impact of introducing novel, ‘enhanced’ reporting strategies was also explored. METHODS: This study was a simulated-patient, randomised, multiple-arm experiment. Patient scenarios were presented to volunteer healthy adult participants via an online survey. In the scenarios, ‘virtual’ patients with low back pain were randomised to one of three groups. Group 1 received imaging and was pre-informed about normal findings. Group 2 received imaging (without pre-information). Group 3 received best practice care: quality information without imaging. Group 1 was further divided to receive either a standard report, or an ‘enhanced’ report (containing altered terminology and epidemiological information). The primary outcome was back-related perceptions (BRP), a composite score derived from three numeric rating scale scores exploring perceptions of spinal condition, recovery concerns and planned activity. The secondary outcomes were satisfaction and kinesiophobia. RESULTS: Full data were available from 660 participants (68% female). Analysis of covariance revealed a significant effect of group after controlling for baseline BRP scores [Image: see text] . Pairwise comparisons indicated that receiving best practice care resulted in more positive BRPs than receiving imaging results, and receiving prior information about normal findings had no impact. Enhanced reporting strategies also positively impacted BRPs [Image: see text] . Significant relationships between group allocation and both satisfaction [Image: see text] and kinaesiophobia [Image: see text] were found, with statistically significant pairwise comparisions again in favour of best-practice care. CONCLUSION: Intervention strategies such as enhanced reporting methods and the provision of quality information (without imaging) have the potential to improve the outcome of patients with recent-onset LBP and should be further considered by primary care providers. PeerJ Inc. 2017-12-06 /pmc/articles/PMC5723139/ /pubmed/29230375 http://dx.doi.org/10.7717/peerj.4151 Text en ©2017 Karran et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ) and either DOI or URL of the article must be cited. |
spellingShingle | Evidence Based Medicine Karran, Emma L. Medalian, Yasmin Hillier, Susan L. Moseley, G. Lorimer The impact of choosing words carefully: an online investigation into imaging reporting strategies and best practice care for low back pain |
title | The impact of choosing words carefully: an online investigation into imaging reporting strategies and best practice care for low back pain |
title_full | The impact of choosing words carefully: an online investigation into imaging reporting strategies and best practice care for low back pain |
title_fullStr | The impact of choosing words carefully: an online investigation into imaging reporting strategies and best practice care for low back pain |
title_full_unstemmed | The impact of choosing words carefully: an online investigation into imaging reporting strategies and best practice care for low back pain |
title_short | The impact of choosing words carefully: an online investigation into imaging reporting strategies and best practice care for low back pain |
title_sort | impact of choosing words carefully: an online investigation into imaging reporting strategies and best practice care for low back pain |
topic | Evidence Based Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5723139/ https://www.ncbi.nlm.nih.gov/pubmed/29230375 http://dx.doi.org/10.7717/peerj.4151 |
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