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Low back pain: influence of early MR imaging or CT on treatment and outcome--multicenter randomized trial.

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 chi(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.

journal_name

Radiology

journal_title

Radiology

authors

Gilbert FJ,Grant AM,Gillan MG,Vale LD,Campbell MK,Scott NW,Knight DJ,Wardlaw D,Scottish Back Trial Group.

doi

10.1148/radiol.2312030886

subject

Has Abstract

pub_date

2004-05-01 00:00:00

pages

343-51

issue

eissn

0033-8419

issn

1527-1315

pii

2312030886

journal_volume

231

pub_type

临床试验,杂志文章,多中心研究,随机对照试验

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Low back pain: influence of early MR imaging or CT on treatment and outcome--multicenter randomized trial.