Reducing Low-Value Imaging for Low Back Pain: Systematic Review With Meta-analysis.
The Journal of Orthopaedic and Sports Physical Therapy
|February 7, 2022
Summary
Interventions to improve guideline-recommended imaging referrals for low back pain showed no significant effect. Education-based strategies are unlikely to be effective, suggesting a need for organizational and policy-level changes.
Area of Science:
- Orthopedics and Sports Physical Therapy
- Health Services Research
Background:
- Guideline-recommended imaging referrals are crucial for managing low back pain.
- Current interventions aim to improve adherence to these guidelines.
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness of interventions designed to enhance guideline-recommended imaging referrals in adult low back pain patients.
Main Methods:
- A systematic literature search was conducted across multiple databases up to June 2021.
- Included were randomized controlled trials and clinical trials; data were synthesized using narrative synthesis and random-effects meta-analysis.
- The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Main Results:
- Eight trials involving 170,460 participants were included; 6 were eligible for meta-analysis.
- Interventions, primarily clinician education with audit/feedback, showed low-certainty evidence of no effect on imaging referrals (OR: 0.87 [0.72, 1.05]).
- The findings remained robust across sensitivity analyses.
Conclusions:
- Interventions to reduce or improve imaging referrals in low back pain demonstrate low-certainty evidence of no effect.
- Clinician education interventions appear ineffective; organizational and policy-level interventions may hold more promise.
