Routine versus needs-based MRI in patients with prolonged low back pain a comparison of duration of treatment, number of clinical contacts and referrals to surgery 英文参考文献.docVIP

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Routine versus needs-based MRI in patients with prolonged low back pain a comparison of duration of treatment, number of clinical contacts and referrals to surgery 英文参考文献.doc

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Routine versus needs-based MRI in patients with prolonged low back pain a comparison of duration of treatment, number of clinical contacts and referrals to surgery 英文参考文献

Jensenetal.ChiropracticOsteopathy2010,18:19 /content/18/1/19 RESEARCH OpenAccess Routineversusneeds-basedMRIinpatientswith prolongedlowbackpain:acomparisonof durationoftreatment,numberofclinicalcontacts andreferralstosurgery RikkeKJensen1,2*,MannicheClaus1,2,CharlotteLeboeuf-Yde1,2 Abstract Background:Theroutineuseofradiologyisnormallydiscouragedinpatientswithlowbackpain(LBP).Magnetic ResonanceImaging(MRI)providescliniciansandpatientswithdetailedknowledgeofspinalstructuresandhasno knownphysicalsideeffects.ItispossiblethatinsightintothepathologicalchangesinLBPpatientscouldaffect patientmanagement.However,toourknowledge,thishasneverbeentested.UntilJune2006,allpatientsatour specialisedout-patientpublicclinicwerereferredforMRIonthebasisofclinicalindications,economicconstraints, andavailabilityofMRI(the“needs-basedMRI”group).Asanewapproach,wenowreferallpatientswhomeet certaincriteriaforroutineup-frontMRIbeforetheclinicalexamination(the“routineMRI”group). Objectives:TheaimsofthisstudyweretoinvestigateifthesetwoMRIapproachesresultedindifferencesin:(1) durationoftreatment,(2)numberofcontactswithclinicians,and(3)referralforsurgery. Design:Comparisonoftworetrospectiveclinicalcohorts. Method:Fileswereretrievedfromconsecutivepatientsinbothgroups.Criteriaforreferralwere:(1)LBPorleg painofatleast3onan11-pointNumericRatingScale,(2)durationofpresentsymptomsfrom2to12monthsand (3)ageabove18years.Acomparisonwasmadebetweenthe“needs-basedMRI”and“routineMRI”groupsonthe outcomesofdurationoftreatmentanduseofresources. Results:Inall,169“needs-basedMRI”and208“routineMRI”patientfileswereidentified.Thetwogroupswere similarinage,sex,andseverityofLBP.However,themediandurationoftreatmentforthe“needs-basedMRI” groupwas160versus115daysinthe“routineMRI”group(p=0.0001).Themediannumberofcontactswith cliniciansforthe“needs-basedMRI”groupwas4versus3forthe“routineMRI”group(p=0.003).Therewasno differencebetweenthetwoapproachesinfrequencyofreferralforbacksurgery(p=0.81).Whenthedirectclinical costswerecom