The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis

Abstract Background Clinical guideline recommendations are against early magnetic resonance imaging (eMRI) within the first 4 to 6 weeks of conservative management of acute low back pain (LBP) without “clinical suspicion” of serious underlying conditions (red flags). There is some limited evidence t...

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Autores principales:	Bara A. Shraim, Muath A. Shraim, Ayman R. Ibrahim, Mohamed E. Elgamal, Basem Al-Omari, Mujahed Shraim
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Systematic review Magnetic resonance imaging Low back pain Sick leave Work disability Return to work Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/eef59171bd7a442c91da9455ca3ffe48
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spelling	oai:doaj.org-article:eef59171bd7a442c91da9455ca3ffe482021-11-28T12:24:22ZThe association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis10.1186/s12891-021-04863-91471-2474https://doaj.org/article/eef59171bd7a442c91da9455ca3ffe482021-11-01T00:00:00Zhttps://doi.org/10.1186/s12891-021-04863-9https://doaj.org/toc/1471-2474Abstract Background Clinical guideline recommendations are against early magnetic resonance imaging (eMRI) within the first 4 to 6 weeks of conservative management of acute low back pain (LBP) without “clinical suspicion” of serious underlying conditions (red flags). There is some limited evidence that a significant proportion of patients with LBP receive eMRI non- indicated by clinical guidelines, which could be associated with increased length of disability (LOD). The aim of this systematic review was to investigate whether eMRI for acute LBP without red flags is associated with increased LOD. The LOD was defined as the number of disability days (absence from work). Methods Medline, EMBASE, and CINAHL bibliographic databases were searched from inception until June 5, 2021. Two reviewers independently assessed the methodological quality of included studies using the Newcastle–Ottawa scale and extracted data for the review. The search identified 324 records, in which seven studies met the inclusion criteria. Three of the included studies used the same study population. Owing to between-study heterogeneity, a narrative synthesis of results was used. Results All included studies were of good methodological quality and consistently reported that patients with acute LBP without red flags who received eMRI had increased LOD compared to those who did not receive eMRI. Three retrospective cohort studies reported that the eMRI groups had a higher mean LOD than the no eMRI groups ranging from 9.4 days (95% CI 8.5, 10.2) to 13.7 days (95% CI 13.0, 14.5) at the end of 1-year follow-up period. The remaining studies reported that the eMRI groups had a higher hazard ratio of work disability ranging between 1.75 (95% CI 1.23, 2.50) and 3.57 (95% CI 2.33, 5.56) as compared to the no eMRI groups. Conclusion eMRI is associated with increased LOD in patients with acute LBP without red flags. Identifying reasons for performing non-indicated eMRI and addressing them with quality improvement interventions may improve adherence to clinical guidelines and improve disability outcomes among patients with LBP.Bara A. ShraimMuath A. ShraimAyman R. IbrahimMohamed E. ElgamalBasem Al-OmariMujahed ShraimBMCarticleSystematic reviewMagnetic resonance imagingLow back painSick leaveWork disabilityReturn to workDiseases of the musculoskeletal systemRC925-935ENBMC Musculoskeletal Disorders, Vol 22, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Systematic review Magnetic resonance imaging Low back pain Sick leave Work disability Return to work Diseases of the musculoskeletal system RC925-935
spellingShingle	Systematic review Magnetic resonance imaging Low back pain Sick leave Work disability Return to work Diseases of the musculoskeletal system RC925-935 Bara A. Shraim Muath A. Shraim Ayman R. Ibrahim Mohamed E. Elgamal Basem Al-Omari Mujahed Shraim The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis
description	Abstract Background Clinical guideline recommendations are against early magnetic resonance imaging (eMRI) within the first 4 to 6 weeks of conservative management of acute low back pain (LBP) without “clinical suspicion” of serious underlying conditions (red flags). There is some limited evidence that a significant proportion of patients with LBP receive eMRI non- indicated by clinical guidelines, which could be associated with increased length of disability (LOD). The aim of this systematic review was to investigate whether eMRI for acute LBP without red flags is associated with increased LOD. The LOD was defined as the number of disability days (absence from work). Methods Medline, EMBASE, and CINAHL bibliographic databases were searched from inception until June 5, 2021. Two reviewers independently assessed the methodological quality of included studies using the Newcastle–Ottawa scale and extracted data for the review. The search identified 324 records, in which seven studies met the inclusion criteria. Three of the included studies used the same study population. Owing to between-study heterogeneity, a narrative synthesis of results was used. Results All included studies were of good methodological quality and consistently reported that patients with acute LBP without red flags who received eMRI had increased LOD compared to those who did not receive eMRI. Three retrospective cohort studies reported that the eMRI groups had a higher mean LOD than the no eMRI groups ranging from 9.4 days (95% CI 8.5, 10.2) to 13.7 days (95% CI 13.0, 14.5) at the end of 1-year follow-up period. The remaining studies reported that the eMRI groups had a higher hazard ratio of work disability ranging between 1.75 (95% CI 1.23, 2.50) and 3.57 (95% CI 2.33, 5.56) as compared to the no eMRI groups. Conclusion eMRI is associated with increased LOD in patients with acute LBP without red flags. Identifying reasons for performing non-indicated eMRI and addressing them with quality improvement interventions may improve adherence to clinical guidelines and improve disability outcomes among patients with LBP.
format	article
author	Bara A. Shraim Muath A. Shraim Ayman R. Ibrahim Mohamed E. Elgamal Basem Al-Omari Mujahed Shraim
author_facet	Bara A. Shraim Muath A. Shraim Ayman R. Ibrahim Mohamed E. Elgamal Basem Al-Omari Mujahed Shraim
author_sort	Bara A. Shraim
title	The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis
title_short	The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis
title_full	The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis
title_fullStr	The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis
title_full_unstemmed	The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis
title_sort	association between early mri and length of disability in acute lower back pain: a systematic review and narrative synthesis
publisher	BMC
publishDate	2021
url	https://doaj.org/article/eef59171bd7a442c91da9455ca3ffe48
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The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis

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