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European Spine Journal

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01-05-2019 | Magnetic Resonance Imaging | Review Article

Imaging versus no imaging for low back pain: a systematic review, measuring costs, healthcare utilization and absence from work

Authors: G. P. G. Lemmers, W. van Lankveld, G. P. Westert, P. J. van der Wees, J. B. Staal

Published in: European Spine Journal | Issue 5/2019

Abstract

Purpose

Imaging (X-ray, CT and MRI) provides no health benefits for low back pain (LBP) patients and is not recommended in clinical practice guidelines. Whether imaging leads to increased costs, healthcare utilization or absence from work is unclear. Therefore, this study systematically reviews if imaging in patients with LBP leads to an increase in these outcomes.

Methods

We searched PubMed, CINAHL, EMBASE, Cochrane Library and Web of Science until October 2017 for randomized controlled trials (RCTs) and observational studies (OSs), comparing imaging versus no imaging on targeted outcomes. Data extraction and risk of bias assessment was performed independently by two reviewers. The quality of the body of evidence was determined using GRADE methodology.

Results

Moderate-quality evidence (1 RCT; n = 421) supports that direct costs increase for patients undergoing X-ray. Low-quality evidence (3 OSs; n = 9535) supports that early MRI may lead to an increase in costs. There is moderate-quality evidence (1 RCT, 2 OSs; n = 3897) that performing MRI or imaging (MRI or CT) is associated with an increase in healthcare utilization (e.g., future injections, surgery, medication, etc.). There is low-quality evidence (5 OSs; n = 15,493) that performing X-ray or MRI is associated with an increase in healthcare utilization. Moderate-quality evidence (2 RCTs; n = 667) showed no significant differences between X-ray or MRI groups compared with non-imaging groups on absence from work. However, low-quality evidence (2 Oss; n = 7765) did show significantly greater mean absence from work in the MRI groups in comparison with the non-imaging groups.

Conclusions

Imaging in LBP may be associated with higher medical costs, increased healthcare utilization and more absence from work.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Available only for authorised users

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Title: Imaging versus no imaging for low back pain: a systematic review, measuring costs, healthcare utilization and absence from work
Authors: G. P. G. Lemmers
W. van Lankveld
G. P. Westert
P. J. van der Wees
J. B. Staal
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Back Pain
Back Pain
Back Pain
Computed Tomography
Computed Tomography
Published in: European Spine Journal / Issue 5/2019
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-019-05918-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Imaging versus no imaging for low back pain: a systematic review, measuring costs, healthcare utilization and absence from work

Abstract

Purpose

Methods

Results

Conclusions

Graphical abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Graphical abstract

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