Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial

Area of Science:

• Primary care and clinical intervention research.
• Health services research focused on diagnostic imaging utilization.
• Patient-physician communication strategies in musculoskeletal care.

Background:

• Patients with acute low back pain often request diagnostic imaging, creating pressure on clinicians.
• Spinal imaging for acute low back pain carries risks, including false positives, patient anxiety, and unnecessary treatments.
• Watchful waiting is a strategy to reduce low-value treatments and may be acceptable to patients.

Purpose of the Study:

• To refine and test a standardized patient-based intervention to teach clinicians how to advise watchful waiting for low back pain.
• To reduce the rate of low-value spinal imaging in patients with acute low back pain.
• To evaluate the generalizability of the intervention to other diagnostic tests.

Main Methods:

• A randomized clinical trial involving 55 clinicians across 8-10 primary and urgent care clinics.
• Intervention group clinicians received training from standardized patient instructors (SPIs) on a three-step model for discussing watchful waiting.
• The primary outcome was the post-intervention rate of spinal imaging for acute low back pain.

Main Results:

• The trial will determine the effectiveness of SPIs in improving clinician skills for negotiating watchful waiting.
• It will assess the impact on reducing low-value spinal imaging rates.
• Secondary outcomes include communication technique use, clinician self-reported watchful waiting, and effects on other pain syndromes.

Conclusions:

• This trial will establish whether standardized patient instructors can effectively train clinicians in advising watchful waiting.
• The study aims to reduce unnecessary spinal imaging for acute low back pain.
• The potential for intervention effects to generalize to other diagnostic tests will be examined.