title: Association of early imaging for back pain with clinical outcomes in older adults.
abstract: OBJECTIVE
  In contrast to the recommendations for younger adults, many guidelines allow for older adults with back pain to undergo imaging without waiting 4 to 6 weeks. However, early imaging may precipitate interventions that do not improve outcomes.
  
  
  OBJECTIVE
  To compare function and pain at the 12-month follow-up visit among older adults who received early imaging with those who did not receive early imaging after a new primary care visit for back pain without radiculopathy.
  
  
  METHODS
  Prospective cohort of 5239 patients 65 years or older with a new primary care visit for back pain (2011-2013) in 3 US health care systems. We matched controls 1:1 using propensity score matching of demographic and clinical characteristics, including diagnosis, pain severity, pain duration, functional status, and prior resource use.
  
  
  METHODS
  Diagnostic imaging (plain films, computed tomography [CT], magnetic resonance imaging [MRI]) of the lumbar or thoracic spine within 6 weeks of the index visit.
  
  
  METHODS
  
  
  
  METHODS
  back or leg pain-related disability measured by the modified Roland-Morris Disability Questionnaire (score range, 0-24; higher scores indicate greater disability) 12 months after enrollment.
  
  
  RESULTS
  Among the 5239 patients, 1174 had early radiographs and 349 had early MRI/CT. At 12 months, neither the early radiograph group nor the early MRI/CT group differed significantly from controls on the disability questionnaire. The mean score for patients who underwent early radiography was 8.54 vs 8.74 among the control group (difference, -0.10 [95% CI, -0.71 to 0.50]; mixed model, P = .36). The mean score for the early MRI/CT group was 9.81 vs 10.50 for the control group (difference,-0.51 [-1.62 to 0.60]; mixed model, P = .18).
  
  
  CONCLUSIONS
  Among older adults with a new primary care visit for back pain, early imaging was not associated with better 1-year outcomes. The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain.
authors.affiliation: Department of Radiology, University of Washington, Seattle2Department of Neurological Surgery, University of Washington, Seattle3Department of Health Services, University of Washington, Seattle4Comparative Effectiveness, Cost and Outcomes Research Center.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Jarvik
authors.affiliation: Department of Radiology, University of Washington, Seattle4Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle11Department of Pharmacy, University of Washington, Seattle.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Gold
authors.affiliation: Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle5Department of Biostatistics, University of Washington, Seattle.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Comstock
authors.affiliation: Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle5Department of Biostatistics, University of Washington, Seattle.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Heagerty
authors.affiliation: Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle7Department of Rehabilitation Medicine, University of Washington, Seattle.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Rundell
authors.affiliation: Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle6Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Turner
authors.affiliation: Division of Research, Northern California Kaiser to Permanente, Oakland.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Avins
authors.affiliation: Department of Radiology, University of Washington, Seattle4Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle.
authors.forename: Zoya
authors.initials: Z
authors.lastname: Bauer
authors.affiliation: Department of Radiology, University of Washington, Seattle4Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Bresnahan
authors.affiliation: Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle7Department of Rehabilitation Medicine, University of Washington, Seattle.
authors.forename: Janna L
authors.initials: JL
authors.lastname: Friedly
authors.affiliation: Department of Radiology, University of Washington, Seattle.
authors.forename: Kathryn
authors.initials: K
authors.lastname: James
authors.affiliation: Department of Health Services, University of Washington, Seattle.
authors.forename: Larry
authors.initials: L
authors.lastname: Kessler
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Spine Unit, Harvard Vanguard Medical Associates, Boston, Massacusetts.
authors.forename: Srdjan S
authors.initials: SS
authors.lastname: Nedeljkovic
authors.affiliation: Neuroscience Institute, Henry Ford Hospital, Detroit, Michigan.
authors.forename: David R
authors.initials: DR
authors.lastname: Nerenz
authors.affiliation: Department of Biostatistics, University of Washington, Seattle.
authors.forename: Xu
authors.initials: X
authors.lastname: Shi
authors.affiliation: Department of Pharmacy, University of Washington, Seattle.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
authors.affiliation: Rehabilitation Medicine Department, Mark O. Hatfield Clinical Research Center, National Institutes of Health, Bethesda, Maryland.
authors.forename: Leighton
authors.initials: L
authors.lastname: Chan
authors.affiliation: Department of Neurosurgery and the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Schwalb
authors.affiliation: Department of Family Medicine, Internal Medicine, and Public Health and Preventive Medicine, and the Oregon Institute for Occupational Health Sciences, Oregon Health and Science University, Portland.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Deyo
mesh_terms: D000368:Aged; D001416:Back Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003365:Costs and Cost Analysis; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D008297:Male; D010147:Pain Measurement; D057216:Propensity Score; D011446:Prospective Studies; D011859:Radiography; D014463:Ultrasonography