Standardized Patient Communication and Low-Value Spinal Imaging: A Randomized Clinical Trial

Area of Science:

• Primary care
• Clinical intervention
• Medical education

Background:

• Acute back pain is a frequent reason for primary care visits.
• Such visits often lead to unnecessary, low-value spinal imaging.
• Developing effective interventions to curb this trend is crucial.

Purpose of the Study:

• To assess the impact of a standardized patient-delivered intervention on low-value spinal imaging rates.
• The intervention aimed to encourage a watchful waiting approach for acute low back pain.

Main Methods:

• A randomized clinical trial involved 53 clinicians across 10 primary care clinics.
• Intervention clinicians received training via simulated office visits with standardized patients.
• Control clinicians received no intervention; outcomes included spinal imaging rates and patient experience.

Main Results:

• No significant difference in lumbar spinal imaging rates between intervention and control groups (15.7% vs 17.3%).
• Rates of cervical and overall imaging also showed no significant differences.
• Patient experience ratings were similar, but intervention clinicians demonstrated improved communication skills.

Conclusions:

• The educational intervention using simulated visits did not significantly reduce low-value spinal imaging.
• While communication skills improved, the primary outcome of reduced imaging was not achieved.
• Further strategies may be needed to modify imaging practices for acute low back pain.