ArticleJournal of general internal medicine2016
Variation among Primary Care Physicians in the Use of Imaging for Older Patients with Acute Low Back Pain.
Article in Journal of general internal medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 52 citations in OpenAlex.
- 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
- Deep Learning-Assisted Lumbar Degeneration Evaluation Using Plain Radiographs: Development and Validation of a Novel Dual-Mechanism Architecture.Neurospine · 2026Article
- Factors Associated with Radiological Examination of Patients with Non-Specific Low Back Pain.Journal of clinical medicine · 2025Article
- Ordering of diagnostic imaging by physical therapists: a multi-center analysis of successful implementation.The Journal of manual & manipulative therapy · 2025Observational
- Diagnostic imaging in the management of older adults with low back pain: analysis from the BAck Complaints in Elders: Chiropractic - Australia cohort study.Chiropractic & manual therapies · 2024Article
- 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
- Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review.BMC medical imaging · 2022Article
- Physicians' clinical experience and its association with healthcare quality: a systematised review.BMJ open quality · 2021Article
- Physician variation in the de-adoption of ineffective statin and fibrate therapy.Health services research · 2021Article
- Are Emergency Medicine Provider Characteristics Associated With Diagnostic Imaging for Low Back Pain?Cureus · 2021Article
- Determinants of Medical Practice Variation Among Primary Care Physicians: Protocol for a Three Phase Study.JMIR research protocols · 2020Article
- Clinician-Level Variation in Three Measures Representing Overuse Based on the American Geriatrics Society Choosing Wisely Statement.Journal of general internal medicine · 2020Article
- Factors Influencing Primary Care Providers' Unneeded Lumbar Spine MRI Orders for Acute, Uncomplicated Low-Back Pain: a Qualitative Study.Journal of general internal medicine · 2020Article
- Removal of Non-economic Damage Caps Is Not Associated with Reductions in Early Imaging for Low Back Pain.HSS journal : the musculoskeletal journal of Hospital for Special Surgery · 2020Article
- Article
- Combining independent decisions increases diagnostic accuracy of reading lumbosacral radiographs and magnetic resonance imaging.PloS one · 2018Article
- Geographic Variation in Diagnostic Ability and Quality of Care Metrics: A Case Study of Ankylosing Spondylitis and Low Back Pain.Inquiry : a journal of medical care organization, provision and financing · 2017Article
- Inflammation in low back pain may be detected from the peripheral blood: suggestions for biomarker.Bioscience reports · 2016Article
- Can Parsimonious Practice Please Patients and Practitioners? The Case of Spine Imaging.Journal of general internal medicine · 2016Article
- Mechanisms of low back pain: a guide for diagnosis and therapy.F1000Research · 2016Review
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
backgroundDiagnostic imaging is not recommended in the evaluation and management of non-specific acute low back pain.
objectiveTo estimate the variation among primary care providers (PCPs) in the use of diagnostic imaging for older patients with non-specific acute low back pain. DESIGN AND
participantsRetrospective cohort study using 100 % Texas Medicare claims data. We identified 145,320 patients aged 66 years and older with non-specific acute low back pain during the period January 1, 2007, through November 30, 2011, cared for by 3297 PCPs. MAIN MEASURES: We tracked whether each patient received lumbar imaging (radiography, computed tomography [CT], or magnetic resonance imaging [MRI]) within 4 weeks of the initial visit. Multilevel logistic regression models were used to estimate physician-level variation in imaging use. KEY
resultsAmong patients, 27.2 % received radiography and 11.1 % received CT or MRI within 4 weeks of the initial visit for low back pain. PCPs varied substantially in the use of imaging. The average rate of radiography within 4 weeks was 53.9 % for PCPs in the highest decile, compared to 6.1 % for PCPs in the lowest decile. The average rates of CT/MRI within 4 weeks were 18.5 % vs. 3.2 % for PCPs in the highest and lowest deciles, respectively. The specific physician seen by a patient accounted for 25 % of the variability in whether imaging was performed, while only 0.44 % of the variance was due to measured patient characteristics and 1.4 % to known physician characteristics. Use of imaging by individual physicians was stable over time.
conclusionsPCPs vary substantially in the use of imaging for non-specific acute low back pain. Provider-level measures can be employed to provide feedback to physicians in an effort to modify imaging use.
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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.