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. 2010 Jan 20;2010(1):CD006094.
doi: 10.1002/14651858.CD006094.pub2.

Interventions for improving the appropriate use of imaging in people with musculoskeletal conditions

Simon D French  1 , Sally Green, Rachelle Buchbinder, Hayley Barnes
Affiliations

Interventions for improving the appropriate use of imaging in people with musculoskeletal conditions

Simon D French et al. Cochrane Database Syst Rev. .

Abstract

Background: Imaging is commonly performed for musculoskeletal conditions. Identifying interventions to improve the appropriate use of imaging for musculoskeletal conditions could potentially result in improved health outcomes for patients and reduced health care costs.

Objectives: To determine the effects of interventions that aim to improve the appropriate use of imaging for people with musculoskeletal conditions.

Search strategy: We searched the Cochrane Effective Practice and Organisation of Care Group Specialised Register (June 2007), The Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2), MEDLINE (January 1966 to June 2007), EMBASE (January 1980 to June 2007) and CINAHL (January 1982 to June 2007). We also searched reference lists of included studies and relevant reviews. We undertook citation searches of all included studies, contacted authors of included studies, and contacted other experts in the field of effective professional practice.

Selection criteria: Randomised controlled trials, non-randomised controlled clinical trials and interrupted time-series analyses that evaluated interventions designed to improve the use of imaging for musculoskeletal symptoms.

Data collection and analysis: Two review authors independently assessed risk of bias and extracted data. We contacted study authors for additional information.

Main results: Twenty eight studies met our inclusion criteria. The majority of the studies were for the management of osteoporosis or low back pain, and most evaluated interventions aimed at health professionals. To improve the use of imaging in the management of osteoporosis, the effect of any type of intervention compared to no-intervention controls was modest (absolute improvement in bone mineral density test ordering +10%, IQR 0.0 to +27.7). Patient mediated, reminder, and organisational interventions appeared to have most potential for improving imaging use in osteoporosis. For low back pain studies, the most common intervention evaluated was distribution of educational materials and this showed varying effects. Other interventions in low back pain studies also showed variable effects. For other musculoskeletal conditions, distribution of educational materials, educational meetings and audit and feedback were not shown to be effective for changing imaging ordering behaviour. Across all conditions, increasing the number of intervention components did not increase effect.

Authors' conclusions: For improving the use of imaging in osteoporosis, most professional interventions demonstrated benefit, and patient mediated, reminder, and organisational interventions appeared to have most potential for benefit. For low back pain studies interventions showed varying effects. For other musculoskeletal conditions, no firm conclusions can be drawn.

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Conflict of interest statement

Three of the review authors (SF, SG and RB) are involved in a trial that, when completed, will be considered for inclusion into this review. This is a cluster RCT of a strategy to implement the Australian acute low back pain guidelines into general practice, and one of the primary outcomes is to reduce the ordering of x‐rays. The expected completion date of this trial is the end of 2009. The study details are available in the table of Characteristics of ongoing studies.

No other conflicts of interest are known.

Figures

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2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies. ITS studies were not judged by this risk of bias assessment method and are represented by the blank space on each bar. See Table 6 for risk of bias assessment of ITS studies
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3
Effect sizes of multifaceted interventions by number of components in intervention study group Due to small number of studies and skewed data, median does not equal mean and hence median line does not appear in the centre of the boxes
See this image and copyright information in PMC

Update of

References

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