Trial reportThe American journal of medicine2014
Impact of IT-enabled intervention on MRI use for back pain.
Trial report in The American journal of medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed, 7 syntheses or guidelines pooled it, 79 citations in OpenAlex.
- Effectiveness of Clinical Decision Support Systems on the Appropriate Use of Imaging for Central Nervous System Injuries: A Systematic Review.Applied clinical informatics · 2022Pooled it
- Interventions to reduce low-value imaging - a systematic review of interventions and outcomes.BMC health services research · 2021Pooled it
- Defining and measuring imaging appropriateness in low back pain studies: a scoping review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2020Pooled it
- Can feedback approaches reduce unwarranted clinical variation? A systematic rapid evidence synthesis.BMC health services research · 2020Pooled it
- Physician-reported barriers to using evidence-based recommendations for low back pain in clinical practice: a systematic review and synthesis of qualitative studies using the Theoretical Domains Framework.Implementation science : IS · 2019Pooled it
- Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2018Pooled it
- Effectiveness of interventions designed to reduce the use of imaging for low-back pain: a systematic review.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2015Pooled it
- Standardized Patient Communication and Low-Value Spinal Imaging: A Randomized Clinical Trial.JAMA network open · 2024Trial
- Impact of Clinical Decision Support on Radiography for Acute Ankle Injuries: A Randomized Trial.The western journal of emergency medicine · 2017Trial
- A multifaceted implementation strategy versus passive implementation of low back pain guidelines in general practice: a cluster randomised controlled trial.Implementation science : IS · 2016Trial
- Reducing inappropriate lumbar MRI referrals: a Danish pre- and post-intervention study.Chiropractic & manual therapies · 2026Article
- The role of electronic health records systems in de-implementing low-value care in primary care: a scoping review.Implementation science communications · 2025Review
- CT Pulmonary Angiogram Clinical Pretest Probability Tool: Impact on Emergency Department Utilization.Journal of the American College of Radiology : JACR · 2024Article
- Clinical Decision Support System Used in Spinal Disorders: Scoping Review.Journal of medical Internet research · 2024Article
- Strategies for de-implementation of low-value care-a scoping review.Implementation science : IS · 2022Article
- Article
- Guideline-concordant utilization of magnetic resonance imaging in adults receiving chiropractic manipulative therapy vs other care for radicular low back pain: a retrospective cohort study.BMC musculoskeletal disorders · 2022Article
- Translating Data Analytics Into Improved Spine Surgery Outcomes: A Roadmap for Biomedical Informatics Research in 2021.Global spine journal · 2022Article
- What behaviour change techniques have been used to improve adherence to evidence-based low back pain imaging?Implementation science : IS · 2021Review
- Unintended consequences: quantifying the benefits, iatrogenic harms and downstream cascade costs of musculoskeletal MRI in UK primary care.BMJ open quality · 2021Article
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundThe purpose of this study was to examine the impact of a multifaceted, clinical decision support (CDS)-enabled intervention on magnetic resonance imaging (MRI) use in adult primary care patients with low back pain.
methodsAfter a baseline observation period, we implemented a CDS targeting lumbar-spine MRI use in primary care patients with low back pain through our computerized physician order entry, as well as 2 accountability tools: mandatory peer-to-peer consultation when test utility was uncertain and quarterly practice pattern variation reports to providers. Our primary outcome measure was rate of lumbar-spine MRI use. Secondary measures included utilization of MRI of any body part, comparing it with that of a concurrent national comparison, as well as proportion of lumbar-spine MRI performed in the study cohort that was adherent to evidence-based guideline. Chi-squared, t-tests, and logistic regression were used to assess pre- and postintervention differences.
resultsIn the study cohort preintervention, 5.3% of low back pain-related primary care visits resulted in lumbar-spine MRI, compared with 3.7% of visits postintervention (P <.0001, adjusted odds ratio 0.68). There was a 30.8% relative decrease (6.5% vs 4.5%, P <.0001, adjusted odds ratio 0.67) in the use of MRI of any body part by the primary care providers in the study cohort. This difference was not detected in the control cohort (5.6% vs 5.3%, P = .712). In the study cohort, adherence to evidence-based guideline in the use of lumbar-spine MRI increased from 78% to 96% (P = .0002).
conclusionsCDS and associated accountability tools may reduce potentially inappropriate imaging in patients with low back pain.
Indexed as
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.