Article Text
Abstract
Objective Overuse of diagnostic imaging for patients with low back pain remains common. The underlying beliefs about diagnostic imaging that could drive overuse remain unclear. We synthesised qualitative research that has explored clinician, patient or general public beliefs about diagnostic imaging for low back pain.
Design A qualitative evidence synthesis using a thematic analysis.
Methods We searched MEDLINE, EMBASE, CINAHL, AMED and PsycINFO from inception to 17 June 2019. Qualitative studies that interviewed clinicians, patients and/or general public exploring beliefs about diagnostic imaging for low back pain were included. Four review authors independently extracted data and organised these according to themes and subthemes. We used the Critical Appraisal Skills Programme tool to critically appraise included studies. To assess confidence in review findings, we used the GRADE-Confidence in the Evidence from Reviews of Qualitative Research method.
Results We included 69 qualitative studies with 1747 participants. Key findings included: Patients and clinicians believe diagnostic imaging is an important test to locate the source of low back pain (33 studies, high confidence); patients with chronic low back pain believe pathological findings on diagnostic imaging provide evidence that pain is real (12 studies, moderate confidence); and clinicians ordered diagnostic imaging to reduce the risk of a missed diagnosis that could lead to litigation, and to manage patients’ expectations (12 studies, moderate confidence).
Conclusion Clinicians and patients can believe that diagnostic imaging is an important tool for locating the source of non-specific low back pain. Patients may underestimate the harms of unnecessary imaging tests. These beliefs could be important targets for intervention.
PROSPERO registration number CRD42017076047.
- qualitative research
- back pain
- magnetic resonance imaging
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Footnotes
Twitter @SweekritiSharma
Contributors Study concept and design: ACT, BR, DAO, TH, CB, RB and CM. Acquisition, analysis, or interpretation of data: all authors. Drafting of the manuscript: SS and ACT. Critical revision of the manuscript for important intellectual content: all authors. Analysis: all authors. Obtained funding: CM and RB. Study supervision: ACT and CM.
Funding ACT is supported by an Australian Government National Health and Medical Research Council (NHMRC) Early Career Fellowship (APP1144026). DAO is supported by an NHMRC Translating Research into Practice Fellowship (APP1168749). TH is supported by an NHMRC Senior Research Fellowship (APP1154607). RB is supported by an NHMRC Senior Principal Research Fellowship (APP1082138). CM is supported by an NHMRC Principal Research Fellowship (APP1103022), a Programme Grant (APP1113532) and Centre for Research Excellence Grant (APP1113532).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.