Evaluating musculoskeletal imaging communication interventions using behavioural science: a scoping review using the...

Area of Science:

• Behavioural science
• Health communication
• Musculoskeletal (MSK) imaging

Background:

• Clinicians and patients often attribute musculoskeletal pain to normal age-related imaging findings, negatively impacting outcomes and increasing costs.
• Existing interventions to improve communication of MSK imaging findings have shown limited success.
• A behavioural science framework is needed to understand and improve these interventions.

Purpose of the Study:

• To identify Behaviour Change Techniques (BCTs), behavioural targets, and theoretical underpinnings of interventions aimed at modifying the communication of musculoskeletal imaging findings.
• To analyze the application of behavioural science principles in current interventions.

Main Methods:

• A scoping review was conducted using the Capability, Opportunity, Motivation - Behaviour (COM-B) model.
• Searches were performed across multiple databases (MEDLINE, EMBASE, CINAHL, AMED, PsycINFO) from inception to February 2024.
• Studies involving interventions to communicate MSK imaging findings to patients and/or clinicians were included, excluding those on serious MSK conditions.

Main Results:

• Eleven studies out of 2486 identified interventions, utilizing 11 different BCTs.
• Commonly used BCTs included framing/reframing, adding objects to the environment, incompatible beliefs, and avoidance of cues.
• Only two studies employed behavioural theory, and most interventions had minimal impact on pain, disability, or fear.

Conclusions:

• There is a notable lack of studies focusing on clinician knowledge and patient resources regarding MSK pain.
• The absence of theory-informed design may explain the limited effectiveness of interventions in reassuring patients about normal imaging findings.
• Future interventions should prioritize enhancing clinician psychological capability and clinician/patient reflective motivation for more effective communication of MSK symptoms.