Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good
Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good
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DOI：
10.2519/jospt.2011.3618
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发表时间：
2011-11-01
影响因子：
6.1
通讯作者：
Chou, Roger
中科院分区：
文献类型：
--
作者：
Flynn, Timothy W.;Smith, Britt;Chou, Roger
在美国，腰椎磁共振成像的比率正在以惊人的速度增长，尽管有证据表明它并没有伴随着患者预后的改善。腰痛患者过度使用腰部成像与过去10年手术率增加2至3倍相关，并可能导致手术率增加2至3倍。此外，患者对成像异常的了解实际上会降低对健康的自我感知，并可能导致恐惧回避和灾难性行为，从而可能使人们容易患上慢性病。本临床评论的目的如下：（1）根据最新指南的定义，描述在腰痛患者中适当使用诊断成像的概述;（2）描述腰椎成像的不适当使用如何增加患者伤害的风险，并导致最近医疗保健费用的大幅增加;（3）为物理治疗师提供明确的指导方针，教育患者适当的成像和信息，以抑制成像对患者感知和健康的潜在负面影响;（4）提供一个成功的临床路径的例子，减少成像和改善结果。* 证据等级：诊断/预后/治疗，5级。J Orthop Sports Phys Ther 2011;41（11）：838-846，Epub 2011年6月3日。doi：10.2519/jospt.2011.3618
The rate of lumbar spine magnetic resonance imaging in the United States is growing at an alarming rate, despite evidence that it is not accompanied by improved patient outcomes. Overutilization of lumbar imaging in individuals with low back pain correlates with, and likely contributes to, a 2- to 3-fold increase in surgical rates over the last 10 years. Furthermore, a patient's knowledge of imaging abnormalities can actually decrease self-perception of health and may lead to fear-avoidance and catastrophizing behaviors that may predispose people to chronicity. The purpose of this clinical commentary is as follows: (1) to describe an outline of the appropriate use, as defined in recent guidelines, of diagnostic imaging in patients with low back pain; (2) to describe how inappropriate use of lumbar spine imaging can increase the risk of patient harm and contributes to the recent large increases in healthcare costs; (3) to provide physical therapists with clear guidelines to educate patients on both appropriate imaging and information to dampen the potential negative effects of imaging on patients' perceptions and health; and (4) to present an example of a successful clinical pathway that has reduced imaging and improved outcomes. *LEVEL Of EVIDENCE: Diagnosis/prognosis/therapy, level 5. J Orthop Sports Phys Ther 2011;41(11):838-846, Epub 3 June 2011. doi:10.2519/jospt.2011.3618