Highlights
- •Routine imaging does not yield beneficial effects in knee/low back pain.
- •Clinicians should avoid imaging when serious underlying conditions are ruled out.
- •Clinical decision rules should be used in patients with traumatic knee complaints.
- •Imaging can be used in non-traumatic knee complaints if conservative treatment fails.
Abstract
Purpose
The increasing use of diagnostic imaging has led to high expenditures, unnecessary
invasive procedures and/or false-positive diagnoses, without certainty that the patients
actually benefit from these imaging procedures. This review explores whether diagnostic
imaging leads to better patient-reported outcomes in individuals with musculoskeletal
disorders.
Method
Databases were searched from inception to September 2013, together with scrutiny of
selected bibliographies. Trials were eligible when: 1) a diagnostic imaging procedure
was compared with any control group not getting or not receiving the results of imaging;
2) the population included individuals suffering from musculoskeletal disorders, and
3) if patient-reported outcomes were available. Primary outcome measures were pain
and function. Secondary outcome measures were satisfaction and quality of life. Subgroup
analysis was done for different musculoskeletal complaints and high technological
medical imaging (MRI/CT).
Results
Eleven trials were eligible. The effects of diagnostic imaging were only evaluated
in patients with low back pain (n = 7) and knee complaints (n = 4). Overall, there was a moderate level of evidence for no benefit of diagnostic imaging
on all outcomes compared with controls. A significant but clinically irrelevant effect
was found in favor of no (routine) imaging in low back pain patients in terms of pain
severity at short [SMD 0.17 (0.04–0.31)] and long-term follow-up [SMD 0.13 (0.02–0.24)],
and for overall improvement [RR 1.15 (1.03–1.28)]. Subgroup analysis did not significantly
change these results.
Conclusion
These results strengthen the available evidence that routine referral to diagnostic
imaging by general practitioners for patients with knee and low back pain yields little
to no benefit.
Abbreviations:
SD (standard deviation), CI (confidence interval), IQR (interquartile range), LBP (low back pain), Gen (generic), Spec (specific), QoL (quality of life), I2 (heterogeneity statistic), Df (degrees of freedom), MRI (magnetic resonance imaging), NRS (numeric rating scale), GPE (global perceived effect), SF-36 (Short Form 36 item), KQoL-26 (Knee Quality of Life 26 item), EQ-5D (EuroQol 5 dimensions), SIP (sickness impact profile), VAS (visual analog scale), ALBP (Aberdeen Low Back Pain Score), FABQ (Fear Avoidance Beliefs Questionnaire), HADS (Hospital Anxiety and Depression Scale), US (United States), UK (United Kingdom)Keywords
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Article info
Publication history
Published online: July 14, 2015
Accepted:
June 27,
2015
Received in revised form:
June 15,
2015
Received:
March 6,
2015
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
