Abstract
Background
An understanding of the patterns of healthcare services used after MRI of the spine in general practice would provide information about how MRI scans are used in primary care.
Aim
To describe the healthcare use of patients referred for lumbar MRI in general practice, and to investigate the association between specific patient characteristics, back pain characteristics and MRI abnormalities with subsequent specialist consultation.
Methods
Patients already referred by their general practitioner for MRI of the lumbar spine were recruited. The MRI radiology reports were scored on abnormalities. The questionnaires filled in at baseline, and at 3 and 12-month follow-up, included potential clinical predictors from history taking and use of healthcare services (consultation, surgery).
Results
Of the 683 included patients being referred for MRI by their general practitioner, 55% were being referred for consultation with a specialist during the first 3 months of follow-up. Patients with no history of back complaints, severe leg pain, more disability, and/or a history of back surgery had a greater chance of being referred to a specialist. Addition of the reported MRI findings did not add to the predictive value of being referred based on only clinical factors.
Conclusion
Our findings suggest that the general practitioners decision whether or not to refer a patient to a specialist was not dependent on the MRI report, but was mostly based on history taking. From a clinical perspective, these results raise questions about the usefulness of the lumbar MRI in general practice patients with low back pain.
Conflicts of interest: No conflicts of interest
Sources of funding for the research: This study is partly funded by a program grant of the Dutch Arthritis Foundation. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
