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

Details

• Personal Author:
  Franklin GM ; Fulton-Kehoe D ; Graves JM ; Jarvik JG ; Martin DP
• Description:
  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. [Description provided by NIOSH]
• Subjects:
  Demography Diagnosis Epidemiology Health Care Facilities Workforce And Services Health Personnel Mental Health Musculoskeletal Diseases Occupational Health Pathology Safety
• Keywords:
  Author Keywords: Low Back Pain Back-injuries Clinical-diagnosis Clinical Practice Guidelines Demographic-characteristics Diagnostic-techniques Diagnostic Imaging Early Imaging Health-care Injuries Magnetic-properties Mathematical-models Medical-equipment Medical-examinations Medical-personnel Medical-services Medical-treatment MRI Musculoskeletal-system-disorders Physicians Population-based Psychological-factors Sociological-factors Statistical-analysis Surgeons Workers' Compensation

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• ISSN:
  0362-2436
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  OSHA Region 10 ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  37
• Issue:
  19
• NIOSHTIC Number:
  nn:20042101
• Citation:
  Spine 2012 Sep; 37(19):1708-1718
• Contact Point Address:
  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
• Email:
  janessa@uw.edu
• Federal Fiscal Year:
  2012
• Performing Organization:
  University of Washington
• Peer Reviewed:
  False
• Start Date:
  20010930
• Source Full Name:
  Spine
• End Date:
  20070929
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:2c72dc31916e77cc955df0d4f1fd95c97f5198b8fab165c62c5320255a25f8b7c2be3609cfa21f99516ed2f02b138c5d4dfce3d3ae476b18fdcd781b5a255ad8
• Download URL:
  https://stacks.cdc.gov/view/cdc/194432/cdc_194432_DS1.pdf
• File Type:
  [PDF - 218.14 KB ]