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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

The reassuring value of diagnostic tests: a systematic review

H van Ravesteijn, I van Dijk, D Darmon, F van de Laar, P Lucassen, TO Hartman, C van Weel, and A Speckens.

Review published: 2012.

Link to full article: [Journal publisher]

CRD summary

This well-conducted review concluded that there was a lack of methodologically sound studies that assessed the reassuring value of diagnostic tests but the available evidence indicated that diagnostic tests made little contribution to patients' level of reassurance. These conclusions are likely to be reliable.

Authors' objectives

To assess the effectiveness of diagnostic tests in providing reassurance to patients.

Searching

PubMed, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus and unspecified trial registries were searched in October 2009. There were no language restrictions. Search terms were reported. Bibliographies of included studies were screened for additional articles.

Study selection

Randomised controlled trials (RCTs) that compared the levels of reassurance in outpatients receiving the results of any diagnostic test with a control group who did not receive tests or who were not given test results were eligible for inclusion.

Included studies were published between 1981 and 2009. Studies measured the reassuring effect of five tests or combinations of tests (electrocardiogram and blood tests for chest pain, radiography of the lumbar spine for low back pain, magnetic resonance imaging for low back pain, magnetic resonance imaging for headache and blood tests for five specified un-explained conditions). All trials were conducted in USA or Europe (two in UK). The primary outcome measure was the level of reassurance (various scales were used). Secondary outcome measures were symptom levels, disability levels and patient satisfaction. Three trials defined reassurance as "taking away the concern that something serious is wrong" and two trials measured absence of anxiety. Reported follow-up ranged from four months to one year.

Three reviewers independently assessed studies for inclusion. Any disagreements were resolved by consultation with a fourth reviewer.

Assessment of study quality

The methodological quality of included studies was assessed for randomisation procedure, allocation concealment, drop-out rate and blinding of the outcome assessor.

Two reviewers independently assessed study quality.

Data extraction

Data were extracted on the baseline and follow-up levels of reassurance or worry in the intervention and control groups and on the direction of effect (with p values).

Three reviewers independently extracted data. Any disagreements were resolved by consultation with a fourth reviewer.

Methods of synthesis

Studies were combined in a narrative synthesis structured by outcome measure.

Results of the review

Five RCTs (1,544 participants) were included in the review. Four out of five studies had adequate randomisation and allocation concealment. Four of the five studies had high drop-out rates (16% to 77%). Only one study reported blinding during outcome assessment.

None of the studies found a significant difference in reassurance levels between intervention and control groups at the end of follow-up; one study found an interim benefit at three months which disappeared at one year follow-up.

Four studies assessed symptom levels and none found a significant difference between intervention and control groups at the end of follow-up. One study found significantly fewer headaches after magnetic resonance imaging in a subgroup of patients with high baseline anxiety and depression scores.

Three studies assessed disability levels and none found a significant difference between intervention and control groups at the end of follow-up.

Three trials assessed patient satisfaction. One trial found that patients who received radiographic investigations of the lumbar spine for lower back pain were significantly more satisfied with their care at the end of nine months follow-up than those who had not. Two studies found no significant difference in patient satisfaction at the end of follow-up.

Authors' conclusions

There was a lack of methodologically sound studies that assessed the reassuring value of diagnostic tests. The available results indicated that diagnostic tests made little contribution to patients' level of reassurance.

CRD commentary

This review assessed the validity of the assumption that diagnostic tests provided reassurance to patients. The authors defined appropriately broad inclusion criteria and searched a range of sources to identify relevant studies. There were no language restrictions. The review process applied measures to minimise error and bias throughout. The methodological quality of included studies was assessed and reported. Use of a narrative synthesis was appropriate given the clear clinical differences between the studies.

The authors noted the lack of high quality evidence. Their conclusions reflected the nature of the available evidence and are likely to be reliable.

Implications of the review for practice and research

Practice: The authors stated that a clear explanation and watchful waiting can make additional diagnostic testing unnecessary. They stated that where diagnostic tests were used it was important to provide adequate pre-test information about normal test results.

Research: The authors stated that more trials were needed to assess the efficacy of specific diagnostic tests in providing reassurance. They stated that future studies should use validated questionnaires for the measurement of reassurance.

Funding

None.

Bibliographic details

van Ravesteijn H, van Dijk I, Darmon D, van de Laar F, Lucassen P, Hartman TO, van Weel C, Speckens A. The reassuring value of diagnostic tests: a systematic review. Patient Education and Counseling 2012; 86(1): 3-8. [PubMed: 21382687]

Indexing Status

Subject indexing assigned by NLM

MeSH

Chest Pain /diagnosis /psychology; Communication; Diagnostic Tests, Routine /psychology /standards; Fear /psychology; Headache /diagnosis /psychology; Humans; Low Back Pain /diagnosis /psychology; Patient Education as Topic; Patient Satisfaction; Physician-Patient Relations; Watchful Waiting

AccessionNumber

12012007765

Database entry date

30/10/2012

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 21382687