The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis
Abstract Background Clinical guideline recommendations are against early magnetic resonance imaging (eMRI) within the first 4 to 6 weeks of conservative management of acute low back pain (LBP) without “clinical suspicion” of serious underlying conditions (red flags). There is some limited evidence t...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-11-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-021-04863-9 |
| _version_ | 1818695293527392256 |
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| author | Bara A. Shraim Muath A. Shraim Ayman R. Ibrahim Mohamed E. Elgamal Basem Al-Omari Mujahed Shraim |
| author_facet | Bara A. Shraim Muath A. Shraim Ayman R. Ibrahim Mohamed E. Elgamal Basem Al-Omari Mujahed Shraim |
| author_sort | Bara A. Shraim |
| collection | DOAJ |
| description | Abstract Background Clinical guideline recommendations are against early magnetic resonance imaging (eMRI) within the first 4 to 6 weeks of conservative management of acute low back pain (LBP) without “clinical suspicion” of serious underlying conditions (red flags). There is some limited evidence that a significant proportion of patients with LBP receive eMRI non- indicated by clinical guidelines, which could be associated with increased length of disability (LOD). The aim of this systematic review was to investigate whether eMRI for acute LBP without red flags is associated with increased LOD. The LOD was defined as the number of disability days (absence from work). Methods Medline, EMBASE, and CINAHL bibliographic databases were searched from inception until June 5, 2021. Two reviewers independently assessed the methodological quality of included studies using the Newcastle–Ottawa scale and extracted data for the review. The search identified 324 records, in which seven studies met the inclusion criteria. Three of the included studies used the same study population. Owing to between-study heterogeneity, a narrative synthesis of results was used. Results All included studies were of good methodological quality and consistently reported that patients with acute LBP without red flags who received eMRI had increased LOD compared to those who did not receive eMRI. Three retrospective cohort studies reported that the eMRI groups had a higher mean LOD than the no eMRI groups ranging from 9.4 days (95% CI 8.5, 10.2) to 13.7 days (95% CI 13.0, 14.5) at the end of 1-year follow-up period. The remaining studies reported that the eMRI groups had a higher hazard ratio of work disability ranging between 1.75 (95% CI 1.23, 2.50) and 3.57 (95% CI 2.33, 5.56) as compared to the no eMRI groups. Conclusion eMRI is associated with increased LOD in patients with acute LBP without red flags. Identifying reasons for performing non-indicated eMRI and addressing them with quality improvement interventions may improve adherence to clinical guidelines and improve disability outcomes among patients with LBP. |
| first_indexed | 2024-12-17T13:43:10Z |
| format | Article |
| id | doaj.art-eef59171bd7a442c91da9455ca3ffe48 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-17T13:43:10Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-eef59171bd7a442c91da9455ca3ffe482022-12-21T21:46:13ZengBMCBMC Musculoskeletal Disorders1471-24742021-11-0122111210.1186/s12891-021-04863-9The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesisBara A. Shraim0Muath A. Shraim1Ayman R. Ibrahim2Mohamed E. Elgamal3Basem Al-Omari4Mujahed Shraim5College of Medicine, QU Health, Qatar UniversityNHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, The University of QueenslandCollege of Medicine, QU Health, Qatar UniversityCollege of Medicine, QU Health, Qatar UniversityCollege of Medicine and Health Sciences, Khalifa UniversityDepartment of Public Health, College of Health Sciences, Qatar University, QU HealthAbstract Background Clinical guideline recommendations are against early magnetic resonance imaging (eMRI) within the first 4 to 6 weeks of conservative management of acute low back pain (LBP) without “clinical suspicion” of serious underlying conditions (red flags). There is some limited evidence that a significant proportion of patients with LBP receive eMRI non- indicated by clinical guidelines, which could be associated with increased length of disability (LOD). The aim of this systematic review was to investigate whether eMRI for acute LBP without red flags is associated with increased LOD. The LOD was defined as the number of disability days (absence from work). Methods Medline, EMBASE, and CINAHL bibliographic databases were searched from inception until June 5, 2021. Two reviewers independently assessed the methodological quality of included studies using the Newcastle–Ottawa scale and extracted data for the review. The search identified 324 records, in which seven studies met the inclusion criteria. Three of the included studies used the same study population. Owing to between-study heterogeneity, a narrative synthesis of results was used. Results All included studies were of good methodological quality and consistently reported that patients with acute LBP without red flags who received eMRI had increased LOD compared to those who did not receive eMRI. Three retrospective cohort studies reported that the eMRI groups had a higher mean LOD than the no eMRI groups ranging from 9.4 days (95% CI 8.5, 10.2) to 13.7 days (95% CI 13.0, 14.5) at the end of 1-year follow-up period. The remaining studies reported that the eMRI groups had a higher hazard ratio of work disability ranging between 1.75 (95% CI 1.23, 2.50) and 3.57 (95% CI 2.33, 5.56) as compared to the no eMRI groups. Conclusion eMRI is associated with increased LOD in patients with acute LBP without red flags. Identifying reasons for performing non-indicated eMRI and addressing them with quality improvement interventions may improve adherence to clinical guidelines and improve disability outcomes among patients with LBP.https://doi.org/10.1186/s12891-021-04863-9Systematic reviewMagnetic resonance imagingLow back painSick leaveWork disabilityReturn to work |
| spellingShingle | Bara A. Shraim Muath A. Shraim Ayman R. Ibrahim Mohamed E. Elgamal Basem Al-Omari Mujahed Shraim The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis BMC Musculoskeletal Disorders Systematic review Magnetic resonance imaging Low back pain Sick leave Work disability Return to work |
| title | The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis |
| title_full | The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis |
| title_fullStr | The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis |
| title_full_unstemmed | The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis |
| title_short | The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis |
| title_sort | association between early mri and length of disability in acute lower back pain a systematic review and narrative synthesis |
| topic | Systematic review Magnetic resonance imaging Low back pain Sick leave Work disability Return to work |
| url | https://doi.org/10.1186/s12891-021-04863-9 |
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