French Simon D, Green Sally, Buchbinder Rachelle, Barnes Hayley
Monash Institute of Health Services Research, Monash University, 43 - 51 Kanooka Grove, Monash Medical Centre, Locked Bag 29, Clayton, VIC, Australia, 3168.
Cochrane Database Syst Rev. 2010 Jan 20;2010(1):CD006094. doi: 10.1002/14651858.CD006094.pub2.
Imaging is commonly performed for musculoskeletal conditions. Identifying interventions to improve the appropriate use of imaging for musculoskeletal conditions could potentially result in improved health outcomes for patients and reduced health care costs.
To determine the effects of interventions that aim to improve the appropriate use of imaging for people with musculoskeletal conditions.
We searched the Cochrane Effective Practice and Organisation of Care Group Specialised Register (June 2007), The Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2), MEDLINE (January 1966 to June 2007), EMBASE (January 1980 to June 2007) and CINAHL (January 1982 to June 2007). We also searched reference lists of included studies and relevant reviews. We undertook citation searches of all included studies, contacted authors of included studies, and contacted other experts in the field of effective professional practice.
Randomised controlled trials, non-randomised controlled clinical trials and interrupted time-series analyses that evaluated interventions designed to improve the use of imaging for musculoskeletal symptoms.
Two review authors independently assessed risk of bias and extracted data. We contacted study authors for additional information.
Twenty eight studies met our inclusion criteria. The majority of the studies were for the management of osteoporosis or low back pain, and most evaluated interventions aimed at health professionals. To improve the use of imaging in the management of osteoporosis, the effect of any type of intervention compared to no-intervention controls was modest (absolute improvement in bone mineral density test ordering +10%, IQR 0.0 to +27.7). Patient mediated, reminder, and organisational interventions appeared to have most potential for improving imaging use in osteoporosis. For low back pain studies, the most common intervention evaluated was distribution of educational materials and this showed varying effects. Other interventions in low back pain studies also showed variable effects. For other musculoskeletal conditions, distribution of educational materials, educational meetings and audit and feedback were not shown to be effective for changing imaging ordering behaviour. Across all conditions, increasing the number of intervention components did not increase effect.
AUTHORS' CONCLUSIONS: For improving the use of imaging in osteoporosis, most professional interventions demonstrated benefit, and patient mediated, reminder, and organisational interventions appeared to have most potential for benefit. For low back pain studies interventions showed varying effects. For other musculoskeletal conditions, no firm conclusions can be drawn.
对于肌肉骨骼疾病，通常会进行影像学检查。确定旨在改善肌肉骨骼疾病影像学合理使用的干预措施，可能会改善患者的健康结局并降低医疗成本。
确定旨在改善肌肉骨骼疾病患者影像学合理使用的干预措施的效果。
我们检索了Cochrane有效实践与护理组织小组专业注册库（2007年6月）、Cochrane对照试验中央注册库（Cochrane图书馆2007年第2期）、MEDLINE（1966年1月至2007年6月）、EMBASE（1980年1月至2007年6月）和CINAHL（1982年1月至2007年6月）。我们还检索了纳入研究的参考文献列表和相关综述。我们对所有纳入研究进行了引文检索，联系了纳入研究的作者，并联系了有效专业实践领域的其他专家。
评估旨在改善肌肉骨骼症状影像学使用的干预措施的随机对照试验、非随机对照临床试验和中断时间序列分析。
两位综述作者独立评估偏倚风险并提取数据。我们联系研究作者获取更多信息。
28项研究符合我们的纳入标准。大多数研究针对骨质疏松症或腰痛的管理，且大多数评估针对卫生专业人员的干预措施。为改善骨质疏松症管理中影像学的使用，与无干预对照组相比任何类型干预措施的效果都较为适度（骨密度检测医嘱开具的绝对改善率为+10%，四分位间距为0.0至+27.7）。患者介导、提醒和组织干预措施在改善骨质疏松症影像学使用方面似乎最具潜力。对于腰痛研究，评估的最常见干预措施是分发教育材料，其效果各异。腰痛研究中的其他干预措施也显示出不同效果。对于其他肌肉骨骼疾病，分发教育材料、召开教育会议以及审核与反馈在改变影像学检查医嘱行为方面未显示出有效性。在所有疾病中，增加干预措施的组成部分并未增加效果。
为改善骨质疏松症中影像学的使用，大多数专业干预措施显示出益处，患者介导、提醒和组织干预措施似乎最具获益潜力。对于腰痛研究，干预措施效果各异。对于其他肌肉骨骼疾病，无法得出确切结论。
