Factors Associated with Radiological Examination of Patients with Non-Specific Low Back Pain

Background/Objectives: Non-specific low back pain (LBP), a highly prevalent musculoskeletal condition, may be associated with overuse of radiological imaging, despite clinical guidelines restricting its use to cases with suspected serious pathology. This study investigated demographic, clinical, and physiotherapy-related factors influencing radiological imaging use in patients with non-specific LBP. Methods: A retrospective cross-sectional study included 179 non-specific LBP patients from an outpatient physiotherapy clinic in Saudi Arabia. Patient data were anonymized and retrieved from electronic health records, including demographic, clinical, physiotherapy and imaging information. Independent variables included patient demographics, non-specific LBP characteristics, physiotherapy engagement, and pain-related outcomes. Descriptive, inferential, and multiple linear regression analyses were conducted to identify predictors of radiological imaging. Results: Among the total study sample (n = 179), 159 (88.8%) patients underwent radiological imaging, primarily X-ray (32.4%) and Magnetic Resonance Imaging (8.4%); 48.0% received multiple imaging modalities. Significant predictors of imaging use included gender (p < 0.001), higher body mass index (BMI) (p = 0.012), greater physiotherapist experience (p = 0.019), and presence of comorbidities (p = 0.023). Non-specific LBP medication use was negatively associated with imaging (p = 0.032). Physiotherapy engagement and pain-related outcomes showed no significant impact on imaging use. Conclusions: Gender, BMI, physiotherapist experience, and comorbidities could influence radiological imaging use in non-specific LBP patients. These findings highlight potential biases in imaging referral patterns and reinforce the need for adherence to evidence-based guidelines to prevent unnecessary imaging, reduce healthcare costs, and enhance patient care.