Study: Barriers May Prevent Clinicians From Following Back Pain Imaging Recommendations

Although national guidelines do not recommend imaging tests for patients with low back pain, barriers may prevent clinicians from following these recommendations, according to results of a recent survey.

Choosing Wisely, a national campaign that advances dialog on avoiding wasteful or unnecessary medical tests, has 7 recommendations against ordering imaging tests for patients with nonspecific low back pain.
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To better understand how clinicians view and follow these guidelines, the researchers selected a random sample of nonresident clinicians at the Department of Veterans Affairs in the United States. The participants completed an online survey, which included demographic information and a hypothetical scenario, from October 6, 2014, to December 8, 2014.

The hypothetical scenario featured a 45-year-old woman with nonspecific low back pain and no red flag symptoms who requested a CT or MRI scan. Participants responded with how they would handle the situation and the factors that influenced their decision. Then they rated the difficulty in following the Choosing Wisely campaign’s recommendations.

Of the 579 participants who completed the survey, 517 (94.2%) would not recommend a CT or MRI scan. Other results included:

  • 18 (3.2%) thought the patient would benefit from the scan.
  • 420 (77.1%) believed that ordering a CT or MRI would lead to future unnecessary tests or procedures.
  • 414 (75.7%) said they would not be able to refer the patient to a specialist without ordering scans first.
  • 316 (57.8%) believed the patient would be upset if scans were not ordered.
  • 141 (25.8%) did not think they would have the time to discuss with the patient the risks and benefits of CT or MRI scans.
  • 149 (27.2%) said that not ordering the scans would leave them vulnerable to a future malpractice claim.

Overall, 14.8% expressed concern over following the Choosing Wisely recommendations, citing liability as a major reason. They stated that greater patient education and attention to referral requirements are needed in order to remove these barriers.

—Amanda Balbi

Reference:

Sears ED, Caverly TJ, Kullgren JT, et al. Clinicians’ perceptions of barriers to avoiding inappropriate imaging for low back pain—knowing is not enough [published online October 17, 2016]. JAMA Intern Med. doi:10.1001/jamainternmed.2016.6364.