Evidence map›Paper›PMID 25733741›Full record

SynthesisCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2015

Effectiveness of interventions designed to reduce the use of imaging for low-back pain: a systematic review.

Hazel J Jenkins, Mark J Hancock, Simon D French, Chris G Maher, Roger M Engel, John S Magnussen

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
57citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

57 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Hazel J JenkinsDepartment of Health Professions (Jenkins, Hancock), Macquarie University, Sydney, Australia; School of Rehabilitation Therapy (French), Queen's University, Kingston, Ont.; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Chiropractic (Engel), Macquarie University, Sydney, Australia; Australian School of Advanced Medicine (Magnussen), Macquarie University, Sydney, Australia hazel.jenkins@mq.edu.au.
Mark J HancockDepartment of Health Professions (Jenkins, Hancock), Macquarie University, Sydney, Australia; School of Rehabilitation Therapy (French), Queen's University, Kingston, Ont.; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Chiropractic (Engel), Macquarie University, Sydney, Australia; Australian School of Advanced Medicine (Magnussen), Macquarie University, Sydney, Australia.
Simon D FrenchDepartment of Health Professions (Jenkins, Hancock), Macquarie University, Sydney, Australia; School of Rehabilitation Therapy (French), Queen's University, Kingston, Ont.; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Chiropractic (Engel), Macquarie University, Sydney, Australia; Australian School of Advanced Medicine (Magnussen), Macquarie University, Sydney, Australia.
Chris G MaherDepartment of Health Professions (Jenkins, Hancock), Macquarie University, Sydney, Australia; School of Rehabilitation Therapy (French), Queen's University, Kingston, Ont.; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Chiropractic (Engel), Macquarie University, Sydney, Australia; Australian School of Advanced Medicine (Magnussen), Macquarie University, Sydney, Australia.
Roger M EngelDepartment of Health Professions (Jenkins, Hancock), Macquarie University, Sydney, Australia; School of Rehabilitation Therapy (French), Queen's University, Kingston, Ont.; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Chiropractic (Engel), Macquarie University, Sydney, Australia; Australian School of Advanced Medicine (Magnussen), Macquarie University, Sydney, Australia.
John S MagnussenDepartment of Health Professions (Jenkins, Hancock), Macquarie University, Sydney, Australia; School of Rehabilitation Therapy (French), Queen's University, Kingston, Ont.; The George Institute for Global Health (Maher), Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Chiropractic (Engel), Macquarie University, Sydney, Australia; Australian School of Advanced Medicine (Magnussen), Macquarie University, Sydney, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRates of imaging for low-back pain are high and are associated with increased health care costs and radiation exposure as well as potentially poorer patient outcomes. We conducted a systematic review to investigate the effectiveness of interventions aimed at reducing the use of imaging for low-back pain.

methodsWe searched MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials from the earliest records to June 23, 2014. We included randomized controlled trials, controlled clinical trials and interrupted time series studies that assessed interventions designed to reduce the use of imaging in any clinical setting, including primary, emergency and specialist care. Two independent reviewers extracted data and assessed risk of bias. We used raw data on imaging rates to calculate summary statistics. Study heterogeneity prevented meta-analysis.

resultsA total of 8500 records were identified through the literature search. Of the 54 potentially eligible studies reviewed in full, 7 were included in our review. Clinical decision support involving a modified referral form in a hospital setting reduced imaging by 36.8% (95% confidence interval [CI] 33.2% to 40.5%). Targeted reminders to primary care physicians of appropriate indications for imaging reduced referrals for imaging by 22.5% (95% CI 8.4% to 36.8%). Interventions that used practitioner audits and feedback, practitioner education or guideline dissemination did not significantly reduce imaging rates. Lack of power within some of the included studies resulted in lack of statistical significance despite potentially clinically important effects.

interpretationClinical decision support in a hospital setting and targeted reminders to primary care doctors were effective interventions in reducing the use of imaging for low-back pain. These are potentially low-cost interventions that would substantially decrease medical expenditures associated with the management of low-back pain.

Indexed as

Primary Health CareDecision Support Systems, ClinicalDiagnostic ImagingFeedbackHealth Care CostsHealth Services MisuseHumansInformation DisseminationLow Back PainMedical AuditPractice Guidelines as TopicReminder Systems

Identifiers

PMID25733741
PMCPMC4387031

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.