Imaging use for low back pain by Ontario primary care clinicians

Protocol for a mixed methods study - The Back on study

Simon D. French*, Michael E. Green, R. Sacha Bhatia, Yingwei Peng, Jill A. Hayden, Jan Hartvigsen, Noah M. Ivers, Jeremy M. Grimshaw, Christopher M. Booth, Lucia Rühland, Kathleen E. Norman

*Corresponding author for this work

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Abstract

Background: At any one time, one in every five Canadians has low back pain (LBP), and LBP is one of the most common health problems in primary care. Guidelines recommend that imaging not be routinely performed in patients presenting with LBP without signs or symptoms indicating a potential pathological cause. Yet imaging rates remain high for many patients who present without such indications. Inappropriate imaging can lead to inappropriate treatments, results in worse health outcomes and causes harm from unnecessary radiation. There is a need to understand the extent of, and factors contributing to, inappropriate imaging for LBP, and to develop effective strategies that target modifiable barriers and facilitators. The primary study objectives are to determine: 1) The rate of, and factors associated with, inappropriate lumbar spine imaging (x-ray, CT scan and MRI) for people with non-specific LBP presenting to primary care clinicians in Ontario; 2) The barriers and facilitators to reduce inappropriate imaging for LBP in primary care settings. Methods: The project will comprise an inception cohort study and a concurrent qualitative study. For the cohort study, we will recruit 175 primary care clinicians (50 each from physiotherapy and chiropractic; 75 from family medicine), and 3750 patients with a new episode of LBP who present to these clinicians. Clinicians will collect data in the clinic, and each participant will be tracked for 12 months using Ontario health administrative and self-reported data to measure diagnostic imaging use and other health outcomes. We will assess characteristics of the clinicians, patients and encounters to identify variables associated with inappropriate imaging. In the qualitative study we will conduct in-depth interviews with primary care clinicians and patients. Discussion: This will be the first Canadian study to accurately document the extent of the overuse of imaging for LBP, and the first worldwide to include data from the main healthcare professions offering primary care for people with LBP. This study will provide robust information about rates of inappropriate imaging for LBP, along with factors associated with, and an understanding of, potential reasons for inappropriate imaging.

Original languageEnglish
Article number50
JournalBMC Musculoskeletal Disorders
Volume20
Number of pages10
ISSN1471-2474
DOIs
Publication statusPublished - 2. Feb 2019

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Ontario
Low Back Pain
Primary Health Care
Cohort Studies
Health
Chiropractic
Diagnostic Imaging
X-Rays
Medicine
Guidelines
Interviews
Delivery of Health Care

Keywords

  • Administrative data analysis
  • Cohort study
  • Diagnostic imaging
  • Low back pain
  • Primary care
  • Qualitative study

Cite this

French, Simon D. ; Green, Michael E. ; Bhatia, R. Sacha ; Peng, Yingwei ; Hayden, Jill A. ; Hartvigsen, Jan ; Ivers, Noah M. ; Grimshaw, Jeremy M. ; Booth, Christopher M. ; Rühland, Lucia ; Norman, Kathleen E. / Imaging use for low back pain by Ontario primary care clinicians : Protocol for a mixed methods study - The Back on study. In: BMC Musculoskeletal Disorders. 2019 ; Vol. 20.
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title = "Imaging use for low back pain by Ontario primary care clinicians: Protocol for a mixed methods study - The Back on study",
abstract = "Background: At any one time, one in every five Canadians has low back pain (LBP), and LBP is one of the most common health problems in primary care. Guidelines recommend that imaging not be routinely performed in patients presenting with LBP without signs or symptoms indicating a potential pathological cause. Yet imaging rates remain high for many patients who present without such indications. Inappropriate imaging can lead to inappropriate treatments, results in worse health outcomes and causes harm from unnecessary radiation. There is a need to understand the extent of, and factors contributing to, inappropriate imaging for LBP, and to develop effective strategies that target modifiable barriers and facilitators. The primary study objectives are to determine: 1) The rate of, and factors associated with, inappropriate lumbar spine imaging (x-ray, CT scan and MRI) for people with non-specific LBP presenting to primary care clinicians in Ontario; 2) The barriers and facilitators to reduce inappropriate imaging for LBP in primary care settings. Methods: The project will comprise an inception cohort study and a concurrent qualitative study. For the cohort study, we will recruit 175 primary care clinicians (50 each from physiotherapy and chiropractic; 75 from family medicine), and 3750 patients with a new episode of LBP who present to these clinicians. Clinicians will collect data in the clinic, and each participant will be tracked for 12 months using Ontario health administrative and self-reported data to measure diagnostic imaging use and other health outcomes. We will assess characteristics of the clinicians, patients and encounters to identify variables associated with inappropriate imaging. In the qualitative study we will conduct in-depth interviews with primary care clinicians and patients. Discussion: This will be the first Canadian study to accurately document the extent of the overuse of imaging for LBP, and the first worldwide to include data from the main healthcare professions offering primary care for people with LBP. This study will provide robust information about rates of inappropriate imaging for LBP, along with factors associated with, and an understanding of, potential reasons for inappropriate imaging.",
keywords = "Administrative data analysis, Cohort study, Diagnostic imaging, Low back pain, Primary care, Qualitative study",
author = "French, {Simon D.} and Green, {Michael E.} and Bhatia, {R. Sacha} and Yingwei Peng and Hayden, {Jill A.} and Jan Hartvigsen and Ivers, {Noah M.} and Grimshaw, {Jeremy M.} and Booth, {Christopher M.} and Lucia R{\"u}hland and Norman, {Kathleen E.}",
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French, SD, Green, ME, Bhatia, RS, Peng, Y, Hayden, JA, Hartvigsen, J, Ivers, NM, Grimshaw, JM, Booth, CM, Rühland, L & Norman, KE 2019, 'Imaging use for low back pain by Ontario primary care clinicians: Protocol for a mixed methods study - The Back on study', BMC Musculoskeletal Disorders, vol. 20, 50. https://doi.org/10.1186/s12891-019-2427-1

Imaging use for low back pain by Ontario primary care clinicians : Protocol for a mixed methods study - The Back on study. / French, Simon D.; Green, Michael E.; Bhatia, R. Sacha; Peng, Yingwei; Hayden, Jill A.; Hartvigsen, Jan; Ivers, Noah M.; Grimshaw, Jeremy M.; Booth, Christopher M.; Rühland, Lucia; Norman, Kathleen E.

In: BMC Musculoskeletal Disorders, Vol. 20, 50, 02.02.2019.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Imaging use for low back pain by Ontario primary care clinicians

T2 - Protocol for a mixed methods study - The Back on study

AU - French, Simon D.

AU - Green, Michael E.

AU - Bhatia, R. Sacha

AU - Peng, Yingwei

AU - Hayden, Jill A.

AU - Hartvigsen, Jan

AU - Ivers, Noah M.

AU - Grimshaw, Jeremy M.

AU - Booth, Christopher M.

AU - Rühland, Lucia

AU - Norman, Kathleen E.

PY - 2019/2/2

Y1 - 2019/2/2

N2 - Background: At any one time, one in every five Canadians has low back pain (LBP), and LBP is one of the most common health problems in primary care. Guidelines recommend that imaging not be routinely performed in patients presenting with LBP without signs or symptoms indicating a potential pathological cause. Yet imaging rates remain high for many patients who present without such indications. Inappropriate imaging can lead to inappropriate treatments, results in worse health outcomes and causes harm from unnecessary radiation. There is a need to understand the extent of, and factors contributing to, inappropriate imaging for LBP, and to develop effective strategies that target modifiable barriers and facilitators. The primary study objectives are to determine: 1) The rate of, and factors associated with, inappropriate lumbar spine imaging (x-ray, CT scan and MRI) for people with non-specific LBP presenting to primary care clinicians in Ontario; 2) The barriers and facilitators to reduce inappropriate imaging for LBP in primary care settings. Methods: The project will comprise an inception cohort study and a concurrent qualitative study. For the cohort study, we will recruit 175 primary care clinicians (50 each from physiotherapy and chiropractic; 75 from family medicine), and 3750 patients with a new episode of LBP who present to these clinicians. Clinicians will collect data in the clinic, and each participant will be tracked for 12 months using Ontario health administrative and self-reported data to measure diagnostic imaging use and other health outcomes. We will assess characteristics of the clinicians, patients and encounters to identify variables associated with inappropriate imaging. In the qualitative study we will conduct in-depth interviews with primary care clinicians and patients. Discussion: This will be the first Canadian study to accurately document the extent of the overuse of imaging for LBP, and the first worldwide to include data from the main healthcare professions offering primary care for people with LBP. This study will provide robust information about rates of inappropriate imaging for LBP, along with factors associated with, and an understanding of, potential reasons for inappropriate imaging.

AB - Background: At any one time, one in every five Canadians has low back pain (LBP), and LBP is one of the most common health problems in primary care. Guidelines recommend that imaging not be routinely performed in patients presenting with LBP without signs or symptoms indicating a potential pathological cause. Yet imaging rates remain high for many patients who present without such indications. Inappropriate imaging can lead to inappropriate treatments, results in worse health outcomes and causes harm from unnecessary radiation. There is a need to understand the extent of, and factors contributing to, inappropriate imaging for LBP, and to develop effective strategies that target modifiable barriers and facilitators. The primary study objectives are to determine: 1) The rate of, and factors associated with, inappropriate lumbar spine imaging (x-ray, CT scan and MRI) for people with non-specific LBP presenting to primary care clinicians in Ontario; 2) The barriers and facilitators to reduce inappropriate imaging for LBP in primary care settings. Methods: The project will comprise an inception cohort study and a concurrent qualitative study. For the cohort study, we will recruit 175 primary care clinicians (50 each from physiotherapy and chiropractic; 75 from family medicine), and 3750 patients with a new episode of LBP who present to these clinicians. Clinicians will collect data in the clinic, and each participant will be tracked for 12 months using Ontario health administrative and self-reported data to measure diagnostic imaging use and other health outcomes. We will assess characteristics of the clinicians, patients and encounters to identify variables associated with inappropriate imaging. In the qualitative study we will conduct in-depth interviews with primary care clinicians and patients. Discussion: This will be the first Canadian study to accurately document the extent of the overuse of imaging for LBP, and the first worldwide to include data from the main healthcare professions offering primary care for people with LBP. This study will provide robust information about rates of inappropriate imaging for LBP, along with factors associated with, and an understanding of, potential reasons for inappropriate imaging.

KW - Administrative data analysis

KW - Cohort study

KW - Diagnostic imaging

KW - Low back pain

KW - Primary care

KW - Qualitative study

U2 - 10.1186/s12891-019-2427-1

DO - 10.1186/s12891-019-2427-1

M3 - Journal article

VL - 20

JO - B M C Musculoskeletal Disorders

JF - B M C Musculoskeletal Disorders

SN - 1471-2474

M1 - 50

ER -