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AuthorShraim, Mujahed
AuthorCifuentes, Manuel
AuthorWilletts, Joanna L
AuthorMarucci-Wellman, Helen R
AuthorPransky, Glenn
Available date2019-12-12T08:25:23Z
Publication Date2019-11-01
Publication NameBMC Musculoskeletal Disorders
Identifierhttp://dx.doi.org/10.1186/s12891-019-2964-7
CitationShraim, M., Cifuentes, M., Willetts, J.L. et al. Why does the adverse effect of inappropriate MRI for LBP vary by geographic location? An exploratory analysis. BMC Musculoskelet Disord 20, 574 (2019) doi:10.1186/s12891-019-2964-7
URIhttp://hdl.handle.net/10576/12387
AbstractEarly magnetic resonance imaging (eMRI) for nonspecific low back pain (LBP) not adherent to clinical guidelines is linked with prolonged work disability. Although the prevalence of eMRI for occupational LBP varies substantially among states, it is unknown whether the risk of prolonged disability associated with eMRI varies according to individual and area-level characteristics. The aim was to explore whether the known risk of increased length of disability (LOD) associated with eMRI scanning not adherent to guidelines for occupational LBP varies according to patient and area-level characteristics, and the potential reasons for any observed variations. A retrospective cohort of 59,360 LBP cases from 49 states, filed between 2002 and 2008, and examined LOD as the outcome. LBP cases with at least 1 day of work disability were identified by reviewing indemnity service records and medical bills using a comprehensive list of codes from the International Classification of Diseases, Ninth Edition (ICD-9) indicating LBP or nonspecific back pain, excluding medically complicated cases. We found significant between-state variations in the negative impact of eMRI on LOD ranging from 3.4 days in Tennessee to 14.8 days in New Hampshire. Higher negative impact of eMRI on LOD was mainly associated with female gender, state workers' compensation (WC) policy not limiting initial treating provider choice, higher state orthopedic surgeon density, and lower state MRI facility density. State WC policies regulating selection of healthcare provider and structural factors affecting quality of medical care modify the impact of eMRI not adherent to guidelines. Targeted healthcare and work disability prevention interventions may improve work disability outcomes in patients with occupational LBP.
SponsorThis study was funded by the Liberty Mutual Research Institute for Safety. The parent company, Liberty Mutual Insurance, had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The publication of this article was funded by the Qatar National Library. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Languageen
PublisherBMC
SubjectCohort study
SubjectGeographic variation in care
SubjectLow back pain
SubjectMagnetic resonance imaging
SubjectWork disability
TitleWhy does the adverse effect of inappropriate MRI for LBP vary by geographic location? An exploratory analysis.
TypeArticle
Volume Number20
ESSN1471-2474


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