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Chiropractic Research Review

Do LBP Patients Overestimate Need for Radiography?

Studies have shown that up to half of low back pain (LBP) radiography examinations may be unnecessary; they yield minimal diagnostic information, they are costly, and they expose patients to unnecessary radiation.

Practitioners often order unnecessary "defensive" tests to alleviate patient fears and avoid malpractice suits.

The objective of this study was to determine how LBP patients who were referred for radiography examinations perceived the necessity of the procedure. Researchers interviewed 99 Norwegian patients undergoing radiography examinations of the lumbosacral spine immediately after the procedure and prior to the radiographs being interpreted.

Seventy-two percent of the patients rated radiography as "very important." Inappropriately referred patients were more likely to consider radiography very important than appropriately referred patients. Women rated the procedure as "very important" less frequently than men, and patients with worsening symptoms rated the importance of radiography high.

This study identified seven issues underlying why patients perceive radiology as important and useful:

* Relating LBP to their symptoms and clinical history;
* Information and advice from their practitioner;
* Need for emotional support from physician;
* Need for certainty and reassurance
* Need for symptom explanation and diagnosis;
* Reliability of radiography vs. clinical evaluation; and
* Expected practical consequences of the radiologic examination.

Patients' views of potentially overrating the importance of radiographs complicate the appropriate use of radiography. However, the authors state, "Addressing these issues may help reduce unnecessary radiography referrals and improve patient care."

Espeland A, Baerheim A, Albrektsen G, et al. Patients' views on importance and usefulness of plain radiography for low back pain. Spine, June 15, 2001: 26, pp. 1356-1363.

Chiropractic Research Review

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