Influence of imaging on clinical decision making in the treatment of lower back pain

Maureen Grace Charles Gillan, Fiona Jane Gilbert, J. E. Andrew, Adrian Maxwell Grant, D. Wardlaw, N. W. Valentine, A. C. Gregori, Scottish Back Trial Group

Research output: Contribution to journalArticlepeer-review

47 Citations (Scopus)


PURPOSE: To assess the impact of cross-sectional imaging with magnetic resonance (MR) imaging or computed tomography (CT) on clinical decision making for patients with lower back pain (LBP).

MATERIALS AND METHODS: A randomized controlled before-and-after study was performed in 145 patients who had symptomatic lumbar spinal disorders and had been referred to orthopedists or neurosurgeons. Participants were a subgroup within a multicenter pragmatic randomized comparison of two imaging policies on LBP treatment: "imaging" versus "no imaging," unless a clear indication developed. Paired assessments were made of diagnosis, diagnostic confidence, proposed treatment, treatment confidence at trial entry acid follow-up, and expectations of imaging. Data were analyzed according to the groups as randomized.

RESULTS: At follow-up, there were no statistically significant differences between the groups with respect to diagnosis or treatment plans. Significant increases in diagnostic and therapeutic confidence between trial entry and follow-up were observed for both groups, with a significantly greater increase in diagnostic confidence (P = .01) in the imaging group.

CONCLUSION: Imaging may increase diagnostic confidence but has minimal influence on diagnostic or therapeutic decisions for patients with LBP. The results highlight the need for evidence-based guidelines for imaging in LBP treatment.

Original languageEnglish
Pages (from-to)393-399
Number of pages6
Issue number2
Publication statusPublished - 2001


  • efficacy study
  • spine, abnormalities
  • technology assessment


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