Patient and public beliefs about the role of imaging in the management of non-specific low back pain: A scoping review

Purpose

Routine imaging for non-specific low back pain is not in line with current guidelines yet imaging continues to occur despite evidence that clinicians are aware of and in agreement with guidelines. Patient and public beliefs regarding imaging may be a driving factor contributing to this and there have been suggestions that patient desire for imaging may lead to inappropriate requests from clinicians.

The objective of this study was to review the current evidence in relation to patient and public beliefs regarding imaging for low back pain.

There is little available evidence on patient and public beliefs about imaging
but what evidence there is suggests that imaging is seen by patients and the public as a positive factor in the management of low back pain...
...Patient desire for a diagnosis
appears to be a big driver of this belief...
...There is also a suggestion that these beliefs
may be being influenced by health care professionals.

Approach

A systematic scoping review was conducted in databases Medline, Embase, Cinahl, Psyc info (inception - Jan 2018). Any method of study of beliefs of adults about imaging for non-specific low back pain was included. Descriptive data was extracted and patient and public beliefs about imaging for low back pain was analysed using conventional qualitative content analysis.

Outcomes

12 studies from an initial search finding of 1135 were analysed. In the included quantitative studies, between 40-73% of patients reported wanting imaging.

Four main themes emerged from qualitative analysis; (1) The desire for imaging; (2) Influences on desire for imaging including patient characteristics, pain presentation and previous experience; (3) Reasons for wanting imaging including diagnosis and treatment planning and the need for reassurance and (4) Patient relationship with clinicians including patient initiative and doubt in clinicians, and patient knowledge of negative consequences of imaging.

There is little available evidence on patient and public beliefs about imaging but what evidence there is suggests that imaging is seen by patients and the public as a positive factor in the management of low back pain. Patient desire for a diagnosis appears to be a big driver of this belief. There is also a suggestion that these beliefs may be being influenced by health care professionals.

Implications

More work is needed to understand the reasons why patients see imaging as essential to the management of their low back pain in order to develop strategies to change unhelpful beliefs and inform patients around the lack of evidence for imaging in non-specific low back pain.

It has also highlighted that patient beliefs may still, in some part, be being driven by some health care professionals which also suggests a need for more targeted education for clinicians.

Further research is needed on this topic, including further exploration of both patient and health care professionals beliefs about imaging for lower back pain, exploration of how the issue around diagnosis can be adequately addressed and strategies for implementing more patient centered decision making when it comes to imaging decisions.

Fund acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This work was undertaken as part of a HEE Clinical Academic Intern Programme.

Additional notes

This work was presented at Physiotherapy UK 2019.