Content analysis of general practitioner-requested lumbar spine X-ray reports

Area of Science:

• Radiology
• Medical Communication
• Pain Management

Background:

• Lumbar spine X-rays for lower back pain often reveal incidental age-related changes rather than serious pathology.
• Patient satisfaction increases post-X-ray, but paradoxically, pain and disability may worsen.
• Psychological factors like illness beliefs and fear avoidance are known predictors of chronic pain and disability.

Purpose of the Study:

• To analyze the specific terminology used by radiologists in lumbar spine X-ray reports.
• To investigate how descriptive language in X-ray reports might influence patient perception and outcomes.
• To determine the frequency of pathological versus descriptive terms for age-related changes.

Main Methods:

• A formal summative content analysis was performed on 120 anonymized lumbar spine X-ray reports from primary care referrals.
• Radiologist-used words were categorized into anatomical, pathological, and descriptive groups.
• The categorization process was refined to ensure mutually exclusive groupings.

Main Results:

• 74% of reports contained phrases indicating degenerative changes.
• Within the 'pathological' category, 47% of terms described age-related changes, and 33% described normal appearances.
• Only 2% of pathological terms explicitly labeled conditions as 'normal for age'.

Conclusions:

• Radiologists frequently employ pathological terminology for common, age-related findings in lumbar spine X-rays.
• This descriptive practice may contribute to patient anxiety and potentially influence the perception of pain and disability.
• Revising communication strategies in radiology reports could improve patient understanding and outcomes for lower back pain.