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JAMA. 2015 Mar 17;313(11):1143-53. doi: 10.1001/jama.2015.1871.

Association of early imaging for back pain with clinical outcomes in older adults.

Author information

  • 1Department of Radiology, University of Washington, Seattle2Department of Neurological Surgery, University of Washington, Seattle3Department of Health Services, University of Washington, Seattle4Comparative Effectiveness, Cost and Outcomes Research Center.
  • 2Department of Radiology, University of Washington, Seattle4Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle11Department of Pharmacy, University of Washington, Seattle.
  • 3Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle5Department of Biostatistics, University of Washington, Seattle.
  • 4Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle7Department of Rehabilitation Medicine, University of Washington, Seattle.
  • 5Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle6Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle.
  • 6Division of Research, Northern California Kaiser to Permanente, Oakland.
  • 7Department of Radiology, University of Washington, Seattle4Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle.
  • 8Department of Radiology, University of Washington, Seattle.
  • 9Department of Health Services, University of Washington, Seattle.
  • 10Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Spine Unit, Harvard Vanguard Medical Associates, Boston, Massacusetts.
  • 11Neuroscience Institute, Henry Ford Hospital, Detroit, Michigan.
  • 12Department of Biostatistics, University of Washington, Seattle.
  • 13Department of Pharmacy, University of Washington, Seattle.
  • 14Rehabilitation Medicine Department, Mark O. Hatfield Clinical Research Center, National Institutes of Health, Bethesda, Maryland.
  • 15Department of Neurosurgery and the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan.
  • 16Department of Family Medicine, Internal Medicine, and Public Health and Preventive Medicine, and the Oregon Institute for Occupational Health Sciences, Oregon Health and Science University, Portland.

Abstract

IMPORTANCE:

In contrast to the recommendations for younger adults, many guidelines allow for older adults with back pain to undergo imaging without waiting 4 to 6 weeks. However, early imaging may precipitate interventions that do not improve outcomes.

OBJECTIVE:

To compare function and pain at the 12-month follow-up visit among older adults who received early imaging with those who did not receive early imaging after a new primary care visit for back pain without radiculopathy.

DESIGN, SETTING, AND PARTICIPANTS:

Prospective cohort of 5239 patients 65 years or older with a new primary care visit for back pain (2011-2013) in 3 US health care systems. We matched controls 1:1 using propensity score matching of demographic and clinical characteristics, including diagnosis, pain severity, pain duration, functional status, and prior resource use.

EXPOSURES:

Diagnostic imaging (plain films, computed tomography [CT], magnetic resonance imaging [MRI]) of the lumbar or thoracic spine within 6 weeks of the index visit.

MAIN OUTCOME AND MEASURES:

PRIMARY OUTCOME:

back or leg pain-related disability measured by the modified Roland-Morris Disability Questionnaire (score range, 0-24; higher scores indicate greater disability) 12 months after enrollment.

RESULTS:

Among the 5239 patients, 1174 had early radiographs and 349 had early MRI/CT. At 12 months, neither the early radiograph group nor the early MRI/CT group differed significantly from controls on the disability questionnaire. The mean score for patients who underwent early radiography was 8.54 vs 8.74 among the control group (difference, -0.10 [95% CI, -0.71 to 0.50]; mixed model, Pā€‰=ā€‰.36). The mean score for the early MRI/CT group was 9.81 vs 10.50 for the control group (difference,-0.51 [-1.62 to 0.60]; mixed model, Pā€‰=ā€‰.18).

CONCLUSIONS AND RELEVANCE:

Among older adults with a new primary care visit for back pain, early imaging was not associated with better 1-year outcomes. The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain.

PMID:
25781443
[PubMed - indexed for MEDLINE]
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