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Factors associated with early magnetic resonance imaging utilization for acute occupational low back pain: a population-based study from Washington State workers' compensation.

Authors
Graves-JM; Fulton-Kehoe-D; Martin-DP; Jarvik-JG; Franklin-GM
Source
Spine 2012 Sep; 37(19):1708-1718
NIOSHTIC No.
20042101
Abstract
STUDY DESIGN: A population-based, prospective cohort study. OBJECTIVE: To identify demographic, job-related, psychosocial, and clinical factors associated with the use of magnetic resonance imaging (MRI) within 6 weeks from injury (early MRI) among workers' compensation claimants with acute occupational low back pain (LBP). SUMMARY OF BACKGROUND DATA: Early MRI may be associated with increased use of services for treatment and costs. To understand utilization and most appropriately apply guidelines, it is important to identify factors associated with early imaging use for occupational LBP. METHODS: Workers (N = 1830) were interviewed 3 weeks (median) after submitting a workers' compensation claim for a back injury. Demographic, work, health, clinical, and injury characteristics were ascertained from interviews, medical records, and administrative data. Modified Poisson regression analyses identified factors associated with early MRI use. RESULTS: Among respondents, 362 (19.8%) received an early MRI. Multivariable regression showed that male workers were 43% more likely to receive an early MRI than female workers (incident rate ratio [IRR]: 1.43, 95% confidence interval [CI]: 1.12-1.82). Initial visit type with a surgeon was associated with 78% greater likelihood of receiving an early MRI than that with a primary care physician (IRR: 1.78, 95% CI: 1.08-2.92). Having a chiropractor as the initial provider was associated with a reduced likelihood of early MRI (IRR: 0.53, 95% CI: 0.42-0.66). Workers with elevated work fear-avoidance, higher Roland scores, or increased injury severity were more likely to receive early MRI than counterparts with lower levels or scores. CONCLUSION: Nearly 20% of the injured workers with LBP receive early MRI, a rate similar to that reported elsewhere. Early MRI may lead to greater subsequent interventions, potentially poorer outcomes, and increased health care expenditures. On the basis of the characteristics of patients with uncomplicated occupational LBP, providers may be able to provide tailored care, and providers and policy makers may better understand the utilization of imaging and adherence to clinical guidelines.
Keywords
Musculoskeletal-system-disorders; Back-injuries; Medical-equipment; Medical-examinations; Demographic-characteristics; Diagnostic-techniques; Magnetic-properties; Medical-treatment; Epidemiology; Pathology; Health-care; Clinical-diagnosis; Sociological-factors; Psychological-factors; Medical-services; Mathematical-models; Physicians; Surgeons; Medical-personnel; Statistical-analysis; Injuries; Author Keywords: low back pain; workers' compensation; diagnostic imaging; early imaging; clinical practice guidelines; MRI; population-based
Contact
Janessa M. Graves, MPH, PhD, Harborview Injury Prevention and Research Center, Department of Pediatrics, School of Medicine, University of Washington, Box 359960, 325 Ninth Ave., Seattle, WA 98104
CODEN
SPINDD
Publication Date
20120901
Document Type
Journal Article
Email Address
janessa@uw.edu
Funding Type
Grant
Fiscal Year
2012
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-R01-OH-004069; Grant-Number-T42-OH-008433
Issue of Publication
19
ISSN
0362-2436
Source Name
Spine
State
WA
Performing Organization
University of Washington
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