Low Back Pain

Influence of Early MR Imaging or CT on Treatment and Outcome—Multicenter Randomized Trial

F.J. Gilbert, M.G.C. Gillan, A.M. Grant, L.D. Vale, M.K. Campbell, N.W. Scott, D.J. Knight, D. Wardlaw

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Abstract
PURPOSE: To establish whether early use of magnetic resonance (MR) imaging or computed tomography (CT) influences treatment and outcome of patients with low back pain (LBP) and whether it is cost-effective.

MATERIALS AND METHODS: In a multicenter randomized study, two imaging policies for LBP were compared in 782 participants with symptomatic lumbar spine disorders who were referred to orthopedists or neurosurgeons. Participants were randomly allocated to early (393 participants; mean age, 43.9 years; range, 16–82 years) or delayed selective (389 participants; mean age, 42.8 years; range, 14–82 years) imaging groups. Delayed selective imaging referred to imaging restricted to patients in whom a clear clinical need subsequently developed. Main outcome measures were Aberdeen Low Back Pain (ALBP) score, Short Form 36 (SF-36) score (for multidimensional health status), EuroQol (EQ-5D) score (for quality-adjusted life-year [QALY] estimates), and healthcare resource use at 8 and 24 months after randomization. Data were evaluated with analysis of covariance, ordinal logistic regression analysis, and ¿2 and Mann-Whitney tests.

RESULTS: Both groups showed improvement in ALBP score, but this was greater in the early group (adjusted mean difference between groups, -3.05 points [95% CI: -5.16, -0.95; P = .005] and -3.62 points [95% CI: -5.92, -1.32; P = .002] at 8 and 24 months, respectively). Scores for SF-36 (bodily pain domain) and EQ-5D were also significantly better at 24 months. Clinical treatment was similar in both groups. Differences in total costs reflected cost of imaging. Imaging provided an adjusted mean additional QALY of 0.041 during 24 months at a mean incremental cost per QALY of $2,124.

CONCLUSION: Early use of imaging does not appear to affect treatment overall. Decisions about the use of imaging depend on judgments concerning whether the small observed improvement in outcome justifies additional cost.
Original languageEnglish
Pages (from-to)343-351
Number of pages9
JournalRadiology
Volume231
Issue number2
Early online date18 May 2004
DOIs
Publication statusPublished - May 2004

Keywords

  • cost-effectiveness
  • efficacy study
  • spine, CT
  • spine, MR
  • quality-of-life
  • lumbar spine
  • primary-care
  • responsiveness
  • SF-36

Cite this

Low Back Pain : Influence of Early MR Imaging or CT on Treatment and Outcome—Multicenter Randomized Trial. / Gilbert, F.J.; Gillan, M.G.C.; Grant, A.M.; Vale, L.D.; Campbell, M.K.; Scott, N.W.; Knight, D.J.; Wardlaw, D.

In: Radiology, Vol. 231, No. 2, 05.2004, p. 343-351.

Research output: Contribution to journalArticle

Gilbert, F.J. ; Gillan, M.G.C. ; Grant, A.M. ; Vale, L.D. ; Campbell, M.K. ; Scott, N.W. ; Knight, D.J. ; Wardlaw, D. / Low Back Pain : Influence of Early MR Imaging or CT on Treatment and Outcome—Multicenter Randomized Trial. In: Radiology. 2004 ; Vol. 231, No. 2. pp. 343-351.
@article{d108299327f24e40ae811a9ee60d91a5,
title = "Low Back Pain: Influence of Early MR Imaging or CT on Treatment and Outcome—Multicenter Randomized Trial",
abstract = "Abstract PURPOSE: To establish whether early use of magnetic resonance (MR) imaging or computed tomography (CT) influences treatment and outcome of patients with low back pain (LBP) and whether it is cost-effective. MATERIALS AND METHODS: In a multicenter randomized study, two imaging policies for LBP were compared in 782 participants with symptomatic lumbar spine disorders who were referred to orthopedists or neurosurgeons. Participants were randomly allocated to early (393 participants; mean age, 43.9 years; range, 16–82 years) or delayed selective (389 participants; mean age, 42.8 years; range, 14–82 years) imaging groups. Delayed selective imaging referred to imaging restricted to patients in whom a clear clinical need subsequently developed. Main outcome measures were Aberdeen Low Back Pain (ALBP) score, Short Form 36 (SF-36) score (for multidimensional health status), EuroQol (EQ-5D) score (for quality-adjusted life-year [QALY] estimates), and healthcare resource use at 8 and 24 months after randomization. Data were evaluated with analysis of covariance, ordinal logistic regression analysis, and ¿2 and Mann-Whitney tests. RESULTS: Both groups showed improvement in ALBP score, but this was greater in the early group (adjusted mean difference between groups, -3.05 points [95{\%} CI: -5.16, -0.95; P = .005] and -3.62 points [95{\%} CI: -5.92, -1.32; P = .002] at 8 and 24 months, respectively). Scores for SF-36 (bodily pain domain) and EQ-5D were also significantly better at 24 months. Clinical treatment was similar in both groups. Differences in total costs reflected cost of imaging. Imaging provided an adjusted mean additional QALY of 0.041 during 24 months at a mean incremental cost per QALY of $2,124. CONCLUSION: Early use of imaging does not appear to affect treatment overall. Decisions about the use of imaging depend on judgments concerning whether the small observed improvement in outcome justifies additional cost.",
keywords = "cost-effectiveness, efficacy study, spine, CT, spine, MR, quality-of-life, lumbar spine, primary-care, responsiveness, SF-36",
author = "F.J. Gilbert and M.G.C. Gillan and A.M. Grant and L.D. Vale and M.K. Campbell and N.W. Scott and D.J. Knight and D. Wardlaw",
note = "MEDLINE{\circledR} is the source for the MeSH terms of this document.",
year = "2004",
month = "5",
doi = "10.1148/radiol.2312030886",
language = "English",
volume = "231",
pages = "343--351",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
number = "2",

}

TY - JOUR

T1 - Low Back Pain

T2 - Influence of Early MR Imaging or CT on Treatment and Outcome—Multicenter Randomized Trial

AU - Gilbert, F.J.

AU - Gillan, M.G.C.

AU - Grant, A.M.

AU - Vale, L.D.

AU - Campbell, M.K.

AU - Scott, N.W.

AU - Knight, D.J.

AU - Wardlaw, D.

N1 - MEDLINE® is the source for the MeSH terms of this document.

PY - 2004/5

Y1 - 2004/5

N2 - Abstract PURPOSE: To establish whether early use of magnetic resonance (MR) imaging or computed tomography (CT) influences treatment and outcome of patients with low back pain (LBP) and whether it is cost-effective. MATERIALS AND METHODS: In a multicenter randomized study, two imaging policies for LBP were compared in 782 participants with symptomatic lumbar spine disorders who were referred to orthopedists or neurosurgeons. Participants were randomly allocated to early (393 participants; mean age, 43.9 years; range, 16–82 years) or delayed selective (389 participants; mean age, 42.8 years; range, 14–82 years) imaging groups. Delayed selective imaging referred to imaging restricted to patients in whom a clear clinical need subsequently developed. Main outcome measures were Aberdeen Low Back Pain (ALBP) score, Short Form 36 (SF-36) score (for multidimensional health status), EuroQol (EQ-5D) score (for quality-adjusted life-year [QALY] estimates), and healthcare resource use at 8 and 24 months after randomization. Data were evaluated with analysis of covariance, ordinal logistic regression analysis, and ¿2 and Mann-Whitney tests. RESULTS: Both groups showed improvement in ALBP score, but this was greater in the early group (adjusted mean difference between groups, -3.05 points [95% CI: -5.16, -0.95; P = .005] and -3.62 points [95% CI: -5.92, -1.32; P = .002] at 8 and 24 months, respectively). Scores for SF-36 (bodily pain domain) and EQ-5D were also significantly better at 24 months. Clinical treatment was similar in both groups. Differences in total costs reflected cost of imaging. Imaging provided an adjusted mean additional QALY of 0.041 during 24 months at a mean incremental cost per QALY of $2,124. CONCLUSION: Early use of imaging does not appear to affect treatment overall. Decisions about the use of imaging depend on judgments concerning whether the small observed improvement in outcome justifies additional cost.

AB - Abstract PURPOSE: To establish whether early use of magnetic resonance (MR) imaging or computed tomography (CT) influences treatment and outcome of patients with low back pain (LBP) and whether it is cost-effective. MATERIALS AND METHODS: In a multicenter randomized study, two imaging policies for LBP were compared in 782 participants with symptomatic lumbar spine disorders who were referred to orthopedists or neurosurgeons. Participants were randomly allocated to early (393 participants; mean age, 43.9 years; range, 16–82 years) or delayed selective (389 participants; mean age, 42.8 years; range, 14–82 years) imaging groups. Delayed selective imaging referred to imaging restricted to patients in whom a clear clinical need subsequently developed. Main outcome measures were Aberdeen Low Back Pain (ALBP) score, Short Form 36 (SF-36) score (for multidimensional health status), EuroQol (EQ-5D) score (for quality-adjusted life-year [QALY] estimates), and healthcare resource use at 8 and 24 months after randomization. Data were evaluated with analysis of covariance, ordinal logistic regression analysis, and ¿2 and Mann-Whitney tests. RESULTS: Both groups showed improvement in ALBP score, but this was greater in the early group (adjusted mean difference between groups, -3.05 points [95% CI: -5.16, -0.95; P = .005] and -3.62 points [95% CI: -5.92, -1.32; P = .002] at 8 and 24 months, respectively). Scores for SF-36 (bodily pain domain) and EQ-5D were also significantly better at 24 months. Clinical treatment was similar in both groups. Differences in total costs reflected cost of imaging. Imaging provided an adjusted mean additional QALY of 0.041 during 24 months at a mean incremental cost per QALY of $2,124. CONCLUSION: Early use of imaging does not appear to affect treatment overall. Decisions about the use of imaging depend on judgments concerning whether the small observed improvement in outcome justifies additional cost.

KW - cost-effectiveness

KW - efficacy study

KW - spine, CT

KW - spine, MR

KW - quality-of-life

KW - lumbar spine

KW - primary-care

KW - responsiveness

KW - SF-36

UR - http://www.scopus.com/inward/record.url?scp=2142752443&partnerID=8YFLogxK

U2 - 10.1148/radiol.2312030886

DO - 10.1148/radiol.2312030886

M3 - Article

VL - 231

SP - 343

EP - 351

JO - Radiology

JF - Radiology

SN - 0033-8419

IS - 2

ER -