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. 2019 Feb 2;20(1):50.
doi: 10.1186/s12891-019-2427-1.

Imaging use for low back pain by Ontario primary care clinicians: protocol for a mixed methods study - the Back ON study

Simon D French  1   2   3 , Michael E Green  4   5 , R Sacha Bhatia  6   7 , Yingwei Peng  5 , Jill A Hayden  8 , Jan Hartvigsen  9   10 , Noah M Ivers  7   11 , Jeremy M Grimshaw  12   13 , Christopher M Booth  14 , Lucia Rühland  15 , Kathleen E Norman  15
Affiliations

Imaging use for low back pain by Ontario primary care clinicians: protocol for a mixed methods study - the Back ON study

Simon D French et al. BMC Musculoskelet Disord. .

Abstract

Background: At any one time, one in every five Canadians has low back pain (LBP), and LBP is one of the most common health problems in primary care. Guidelines recommend that imaging not be routinely performed in patients presenting with LBP without signs or symptoms indicating a potential pathological cause. Yet imaging rates remain high for many patients who present without such indications. Inappropriate imaging can lead to inappropriate treatments, results in worse health outcomes and causes harm from unnecessary radiation. There is a need to understand the extent of, and factors contributing to, inappropriate imaging for LBP, and to develop effective strategies that target modifiable barriers and facilitators. The primary study objectives are to determine: 1) The rate of, and factors associated with, inappropriate lumbar spine imaging (x-ray, CT scan and MRI) for people with non-specific LBP presenting to primary care clinicians in Ontario; 2) The barriers and facilitators to reduce inappropriate imaging for LBP in primary care settings.

Methods: The project will comprise an inception cohort study and a concurrent qualitative study. For the cohort study, we will recruit 175 primary care clinicians (50 each from physiotherapy and chiropractic; 75 from family medicine), and 3750 patients with a new episode of LBP who present to these clinicians. Clinicians will collect data in the clinic, and each participant will be tracked for 12 months using Ontario health administrative and self-reported data to measure diagnostic imaging use and other health outcomes. We will assess characteristics of the clinicians, patients and encounters to identify variables associated with inappropriate imaging. In the qualitative study we will conduct in-depth interviews with primary care clinicians and patients.

Discussion: This will be the first Canadian study to accurately document the extent of the overuse of imaging for LBP, and the first worldwide to include data from the main healthcare professions offering primary care for people with LBP. This study will provide robust information about rates of inappropriate imaging for LBP, along with factors associated with, and an understanding of, potential reasons for inappropriate imaging.

Keywords: Administrative data analysis; Cohort study; Diagnostic imaging; Low back pain; Primary care; Qualitative study.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics clearance for this study was provided by the Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board (REH-736-18). The ethics approval covers all sites, and individual sites will give permission to carry out research and collect patient data as part of the consent process. All participants will provide written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors have no competing interests to declare.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of participant recruitment and data collection
See this image and copyright information in PMC

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