Influence of imaging on clinical decision making in the treatment of lower back pain.
OBJECTIVE
To assess the impact of cross-sectional imaging with magnetic resonance (MR) imaging or computed tomography (CT) on clinical decision making for patients with lower back pain (LBP).


METHODS
A randomized controlled before-and-after study was performed in 145 patients who had symptomatic lumbar spinal disorders and had been referred to orthopedists or neurosurgeons. Participants were a subgroup within a multicenter pragmatic randomized comparison of two imaging policies on LBP treatment: "imaging" versus "no imaging," unless a clear indication developed. Paired assessments were made of diagnosis, diagnostic confidence, proposed treatment, treatment confidence at trial entry and follow-up, and expectations of imaging. Data were analyzed according to the groups as randomized.


RESULTS
At follow-up, there were no statistically significant differences between the groups with respect to diagnosis or treatment plans. Significant increases in diagnostic and therapeutic confidence between trial entry and follow-up were observed for both groups, with a significantly greater increase in diagnostic confidence (P =.01) in the imaging group.


CONCLUSIONS
Imaging may increase diagnostic confidence but has minimal influence on diagnostic or therapeutic decisions for patients with LBP. The results highlight the need for evidence-based guidelines for imaging in LBP treatment.
Gillan
M G
MG
Department of Radiology, University of Aberdeen, Foresterhill, AB25 2ZD, Scotland, UK. m.g.gillan@abdn.ac.uk
Gilbert
F J
FJ
Andrew
J E
JE
Grant
A M
AM
Wardlaw
D
D
Valentine
N W
NW
Gregori
A C
AC
D000328:Adult; D001416:Back Pain / Q000175:diagnosis* / Q000628:therapy*; D003657:Decision Making; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010347:Patient Care Planning; D014057:Tomography, X-Ray Computed