Providing Epidemiologic Data in Lumbar Spine Imaging Reports Did Not Affect Subsequent Utilization of Spine Procedures: Secondary Outcomes from a Stepped-Wedge Randomized Controlled Trial

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Pain medicine


OBJECTIVE: To evaluate the effect of inserting epidemiologic information into lumbar spine imaging reports on subsequent non-surgical and surgical procedures involving the thoracolumbosacral spine and sacroiliac (SI) joints.

DESIGN: Analysis of secondary outcomes from the Lumbar Imaging with Reporting of Epidemiology (LIRE) pragmatic stepped-wedge randomized trial.

SETTING: Primary care clinics within four integrated healthcare systems in the United States.

SUBJECTS: 238,886 patients aged ≥18 years who received lumbar diagnostic imaging between 2013-2016.

METHODS: Clinics were randomized to receive text containing age- and modality-specific epidemiologic benchmarks indicating the prevalence of common spine imaging findings in people without low back pain, inserted into lumbar spine imaging reports (the "LIRE intervention"). The study outcomes were receiving (1) any non-surgical lumbosacral or sacroiliac spine procedure (lumbosacral epidural steroid injection, facet joint injection, or facet joint radiofrequency ablation; or sacroiliac joint injection) or (2) any surgical procedure involving the lumbar, sacral, or thoracic spine (decompression surgery or spinal fusion or other spine surgery).

RESULTS: The LIRE intervention was not significantly associated with subsequent utilization of non-surgical lumbosacral or sacroiliac spine procedures (odds ratio [OR]=1.01, 95% confidence interval [CI] 0.93-1.09; p = 0.79) or any surgical procedure (OR = 0.99, 95 CI 0.91-1.07; p = 0.74) involving the lumbar, sacral, or thoracic spine. The intervention was also not significantly associated with any individual spine procedure.

CONCLUSIONS: Inserting epidemiologic text into spine imaging reports had no effect on non-surgical or surgical procedure utilization among patients receiving lumbar diagnostic imaging.

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ePub ahead of print