Reducing low-value imaging for low back pain : Systematic review with meta-analysis

Journal article


Belavy, Daniel L., Tagliaferri, Scott D., Buntine, Paul, Saueressig, Tobias, Samanna, Claire, McGuckian, Thomas, Miller, Clint T. and Owen, Patrick J.. (2022). Reducing low-value imaging for low back pain : Systematic review with meta-analysis. Journal of Orthopaedic and Sports Physical Therapy. 52(4), pp. 175-191. https://doi.org/10.2519/jospt.2022.10731
AuthorsBelavy, Daniel L., Tagliaferri, Scott D., Buntine, Paul, Saueressig, Tobias, Samanna, Claire, McGuckian, Thomas, Miller, Clint T. and Owen, Patrick J.
Abstract

Objective
To examine the effectiveness of implementing interventions to improve guideline-recommended imaging referrals in low back pain.

Design
Systematic review with meta-analysis.

Literature Search
We searched MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials from inception to June 14, 2021, as well as Google Scholar and reference lists of relevant systematic reviews published in the last 10 years. We conducted forward and backward citation tracking.

Study Selection Criteria
Randomized controlled or clinical trials in adults with low back pain to improve imaging referrals.

Data Synthesis
Bias was assessed using the Cochrane Risk of Bias 2 tool. Data were synthesized using narrative synthesis and random-effects meta-analysis (Hartung-Knapp-Sidik-Jonkman method). We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.

Results
Of the 2719 identified records, 8 trials were included, with 6 studies eligible for meta-analysis (participants: N = 170 460). All trials incorporated clinician education; 4 included audit and/or feedback components. Comparators were no-intervention control and passive dissemination of guidelines. Five trials were rated as low risk of bias, and 2 trials were rated as having some concerns. There was low-certainty evidence that implementing interventions to improve guideline-recommended imaging referrals had no effect (odds ratio [95% confidence interval]: 0.87 [0.72, 1.05]; I2 = 0%; studies: n = 6). The main finding was robust to sensitivity analyses.

Conclusion
We found low-certainty evidence that interventions to reduce imaging referrals or use in low back pain had no effect. Education interventions are unlikely to be effective. Organizational- and policy-level interventions are more likely to be effective.

Keywordsdiagnostic imaging; low back pain; meta-analysis; systematic review
Year2022
JournalJournal of Orthopaedic and Sports Physical Therapy
Journal citation52 (4), pp. 175-191
PublisherJournal of Orthopaedic & Sports Physical Therapy, Inc.
ISSN0190-6011
Digital Object Identifier (DOI)https://doi.org/10.2519/jospt.2022.10731
PubMed ID35128942
Scopus EID2-s2.0-85128802524
Page range175-191
Author's accepted manuscript
File Access Level
Controlled
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online20 Apr 2022
Publication process dates
Deposited03 Mar 2023
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