From the Faculty of Medicine, Health and Human Sciences (J.L.W., H.J.J., G.H.I., J.S.M., M.J.H), Macquarie University, Sydney, New South Wales, Australia
From the Faculty of Medicine, Health and Human Sciences (J.L.W., H.J.J., G.H.I., J.S.M., M.J.H), Macquarie University, Sydney, New South Wales, Australia.
AJNR Am J Neuroradiol. 2022 Mar;43(3):493-500. doi: 10.3174/ajnr.A7432. Epub 2022 Feb 24.
Patients and clinicians may misinterpret the clinical importance of imaging findings in patients with low back pain, leading to potential harm related to overdiagnosis.
Our aims were to qualitatively summarize the characteristics of tested interventions that target the reporting, communication, or clinical interpretation of lumbar imaging findings and determine whether interventions are effective in improving low back pain-related health outcomes, health care use, or health care costs.
PubMed, MEDLINE, CINAHL, EMBASE, PsycINFO, and the Cochrane Library were searched from inception to October 20, 2021.
The search retrieved 4394 articles, nine articles (seven studies) met the inclusion criteria to summarize intervention characteristics. Five of these studies had an adequate design for evaluating intervention effectiveness.
Intervention characteristics were summarized using the Template for Intervention Description and Replication checklist. Effectiveness data were extracted from short, intermediate, and long-term follow-up points. Studies were assessed for risk of bias, and Grading of Recommendations Assessment, Development and Evaluation methodology was used to determine the certainty of the evidence.
Four studies investigated the insertion of prevalence information into imaging reports. Single studies investigated withholding diagnostic information, education, and reassurance. Moderate-quality evidence (from 1 study) suggests that inserting prevalence information into imaging reports probably does not change the overall health care use in the long-term but may reduce opioid prescribing.
The available evidence is limited, and a meta-analysis was not possible.
Further work is required to develop and test interventions that target the reporting, communication, and clinical interpretation of lumbar imaging findings that may reduce overdiagnosis and improve the management of low back pain.
患者和临床医生可能会误解腰痛患者影像学发现的临床重要性，导致潜在的过度诊断相关危害。
我们的目的是定性总结针对腰椎影像学发现报告、沟通或临床解读的干预措施的特点，并确定这些干预措施是否能有效改善腰痛相关健康结局、医疗保健使用或医疗保健费用。
从建库到 2021 年 10 月 20 日，我们在 PubMed、MEDLINE、CINAHL、EMBASE、PsycINFO 和 Cochrane Library 中进行了检索。
搜索共检索到 4394 篇文章，9 篇文章（7 项研究）符合纳入标准，以总结干预措施的特点。其中 5 项研究具有评估干预效果的适当设计。
使用干预措施描述和复制清单对干预措施特点进行总结。从短期、中期和长期随访点提取有效性数据。对研究进行偏倚风险评估，并使用推荐评估、制定与评价方法学评估证据的确定性。
4 项研究调查了将患病率信息插入影像学报告中的效果。单篇研究调查了隐瞒诊断信息、教育和保证的效果。一项研究提供的中等质量证据表明，将患病率信息插入影像学报告中可能不会长期改变整体医疗保健使用情况，但可能会减少阿片类药物的开具。
现有证据有限，无法进行荟萃分析。
需要进一步开发和测试针对腰椎影像学发现报告、沟通和临床解读的干预措施，以减少过度诊断并改善腰痛的管理。
