A new study from UC Davis Health reveals that a communication-based intervention aimed at reducing unnecessary spinal imaging for lower back pain did not yield the desired results. The research, published in JAMA Network Open, explored whether training primary care physicians in specific communication strategies could decrease the rate of low-value lumbar spinal imaging. Despite improving physician empathy and patient engagement, the intervention failed to significantly impact imaging rates.
The Challenge of Low Back Pain and Over-Imaging
Lower back pain is a widespread issue, affecting an estimated 75-85% of Americans at some point in their lives and is the single leading cause of disability worldwide. While imaging is often requested by patients seeking quick answers, it frequently provides little clinical benefit and can lead to unnecessary procedures based on false positives. "We have a problem in the United States of providing low-value services that are expensive, offer little or no benefit and are utilized at high rates," said Joshua Fenton, professor at UC Davis Health and lead author of the study.
Study Design and Results
The study involved 53 primary care physicians across 10 clinics in the Sacramento area. Physicians in the intervention group participated in three 20-minute simulated office visits over six months, where actors playing patients with lower back pain provided feedback on communication techniques. The primary outcome was the rate of lumbar spinal imaging within 90 days of a low back pain visit, with an 18-month follow-up period. The imaging rates were similar between the intervention (15.7%) and control (17.3%) groups.
Implications and Future Directions
While the intervention did not reduce imaging rates, it did show a positive impact on physician empathy and elicitation of patient perspectives. The researchers hypothesize that the already low imaging rates among the participating physicians, compared to national averages, may have contributed to the lack of significant reduction. "Alongside other evidence, we believe our study shows physician educational interventions are simply not going to reduce low-value imaging," Fenton noted. The findings suggest that more systemic approaches within healthcare systems may be necessary to address the issue of over-imaging for low back pain.
