Reducing inappropriate lumbar MRI referrals: a Danish pre- and post-intervention study.
C Bell1, S B Krogh1,2, P Vedsted1,3
1University Clinic for Innovative Patient Pathways, Medical Diagnostic Center, Regional Hospital Central Jutland, Silkeborg, Denmark.
Chiropractic & Manual Therapies
|July 4, 2026
Summary
An intervention improved appropriate lumbar spine MRI referrals for low back pain, increasing appropriateness by 10.3%. However, the reduction in MRIs performed may not be sustained long-term.
Area of Science:
- Radiology
- Health Services Research
- Clinical Practice Guidelines
Background:
- Low back pain (LBP) is a leading global cause of disability.
- Guidelines recommend against routine lumbar spine MRI, yet inappropriate referrals persist.
- General Practitioners (GPs) frequently refer patients for lumbar MRI without clear indications.
Purpose of the Study:
- To evaluate an intervention's effect on the appropriateness of lumbar spine MRI referrals.
- To assess the impact on the proportion of patients undergoing lumbar MRI after referral.
Main Methods:
- Quasi-experimental design with pre- and post-intervention periods (Jan 2019 - Aug 2023).
- Intervention: Template-based letters and a guidance booklet for GPs.
- Interrupted time-series analysis to assess changes in referral appropriateness and MRI rates.
Main Results:
- Appropriate referrals increased from 49.7% to 60.0% post-intervention.
- The proportion of patients undergoing lumbar MRI decreased from 92.2% to 75.7%.
- An initial reduction in MRIs was observed, but the trend suggested a potential return to pre-intervention levels.
Conclusions:
- The intervention successfully enhanced the appropriateness of lumbar spine MRI referrals.
- While an immediate decrease in lumbar MRIs was noted, long-term sustainability is uncertain.