Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain.
OBJECTIVE
We conducted a prospective randomized study of patients with acute low back pain and/or radiculopathy to assess the effect of knowledge of diagnostic findings on clinical outcome. The practice of ordering spinal imaging, perhaps unintentionally, includes a large number of patients for whom the imaging test is performed for purposes of reassurance or because of patient expectations. If this rationale is valid, one would expect to see a measurable effect from diagnostic information, per se.


METHODS
A total of 246 patients with acute (<3 weeks) low back pain (LBP) and/or radiculopathy (150 LBP and 96 radiculopathy patients) were recruited. Patients were randomized using a stratified block design with equal allocation to either the unblinded group (MR imaging results provided within 48 hours) or the blinded group (both patient and physician blinded to MR imaging results.) After the initial MR imaging, patients followed 6 weeks of conservative management. Roland function, visual pain analog, absenteeism, Short Form (SF)-36 Health Status Survey, self-efficacy scores, and Fear Avoidance Questionnaire were completed at presentation; 2, 4, 6, and 8 weeks; and 6, 12, and 24 months. Improvement of Roland score by 50% or more and patient satisfaction assessed by Cherkin symptom satisfaction measure were considered a positive outcome.


RESULTS
Clinical outcome at 6 weeks was similar for unblinded and blinded patients. Self-efficacy, fear avoidance beliefs, and the SF-36 subscales were similar over time for blinded and unblinded patients, except for the general health subscale on the SF-36. General health of the blinded group improved more than for the unblinded group (P = .008).


CONCLUSIONS
Patient knowledge of imaging findings do not alter outcome and are associated with a lesser sense of well-being.
Ash
L M
LM
Division of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA. lorrainemash@gmail.com
Modic
M T
MT
Obuchowski
N A
NA
Ross
J S
JS
Brant-Zawadzki
M N
MN
Grooff
P N
PN
D000208:Acute Disease; D000328:Adult; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D009820:Ohio / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010147:Pain Measurement / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D011843:Radiculopathy / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D016896:Treatment Outcome