Consumer understanding of terms used in imaging reports requested for low back pain: a cross-sectional survey

Caitlin Farmer; Denise A O'Connor; Hopin Lee; Kirsten McCaffery; Christopher Maher; Dave Newell; Aidan Cashin; David Byfield; Jeffrey Jarvik; Rachelle Buchbinder

doi:10.1136/bmjopen-2021-049938

Consumer understanding of terms used in imaging reports requested for low back pain: a cross-sectional survey

BMJ Open. 2021 Sep 13;11(9):e049938. doi: 10.1136/bmjopen-2021-049938.

Authors

Caitlin Farmer^{1

2}, Denise A O'Connor^{3

2}, Hopin Lee^{4

5}, Kirsten McCaffery⁶, Christopher Maher^{7

8}, Dave Newell⁹, Aidan Cashin^{10

11}, David Byfield¹², Jeffrey Jarvik^{13

14}, Rachelle Buchbinder^{3

2}

Affiliations

¹ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia caitlin.farmer1@monash.edu.
² Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, Victoria, Australia.
³ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁴ Centre for Statistics in Medicine, Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, Oxfordshire, UK.
⁵ School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.
⁶ Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
⁷ School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
⁸ The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, Australia.
⁹ AECC University College, Dorset, UK.
¹⁰ Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia.
¹¹ Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
¹² University of South Wales Faculty of Life Sciences and Education, Treforest, UK.
¹³ Departments of Radiology, Neurological Surgery and Health Services, School of Medicine, University of Washington, Seattle, Washington, USA.
¹⁴ UW Clinical Learning, Evidence And Research (CLEAR) Center for Musculoskeletal Disorders, University of Washington, Seattle, Washington, USA.

Abstract

Objectives: To investigate (1) self-reported societal comprehension of common and usually non-serious terms found in lumbar spine imaging reports and (2) its relationship to perceived seriousness, likely persistence of low back pain (LBP), fear of movement, back beliefs and history and intensity of LBP.

Design: Cross-sectional online survey of the general public.

Setting: Five English-speaking countries: UK, USA, Canada, New Zealand and Australia.

Participants: Adults (age >18 years) with or without a history of LBP recruited in April 2019 with quotas for country, age and gender.

Primary and secondary outcome measures: Self-reported understanding of 14 terms (annular fissure, disc bulge, disc degeneration, disc extrusion, disc height loss, disc protrusion, disc signal loss, facet joint degeneration, high intensity zone, mild canal stenosis, Modic changes, nerve root contact, spondylolisthesis and spondylosis) commonly found in lumbar spine imaging reports. For each term, we also elicited worry about its seriousness, and whether its presence would indicate pain persistence and prompt fear of movement.

Results: From 774 responses, we included 677 (87.5%) with complete and valid responses. 577 (85%) participants had a current or past history of LBP of whom 251 (44%) had received lumbar spine imaging. Self-reported understanding of all terms was poor. At best, 235 (35%) reported understanding the term 'disc degeneration', while only 71 (10.5%) reported understanding the term 'Modic changes'. For all terms, a moderate to large proportion of participants (range 59%-71%), considered they indicated a serious back problem, that pain might persist (range 52%-71%) and they would be fearful of movement (range 42%-57%).

Conclusion: Common and usually non-serious terms in lumbar spine imaging reports are poorly understood by the general population and may contribute to the burden of LBP.

Trial registration number: ACTRN12619000545167.

Keywords: Musculoskeletal disorders; back pain; diagnostic radiology.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Cross-Sectional Studies
Humans
Intervertebral Disc Degeneration* / diagnostic imaging
Low Back Pain* / diagnostic imaging
Lumbar Vertebrae / diagnostic imaging
Magnetic Resonance Imaging

Grants and funding

P30 AR072572/AR/NIAMS NIH HHS/United States