Catastrophization Effects of MRI Reports
A recent study aimed to explore the impact of the language used in MRI reports on pain levels in people with chronic low back pain.
We reviewed this study in the latest issue of our Research Reviews – where industry experts break down the most recent and clinically relevant studies, for immediate application in the clinic.
What you’ll read below is a snippet from the review.
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Back to the study!
STUDY TITLE: The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: results from an RCT and blinded trials – Rajasekaran et al (2021)
Study reviewed by Ben Cormack in the May 2021 issue of the Research Reviews
Key points from the study
- MRIs can lead to greater healthcare utilization but without improved outcomes.
- Changing the reporting of MRIs to include an element of reassurance had a large positive effect over factual reporting.
Background and Objective
Lumbar spine surgery is more frequently being used to treat low back pain (LBP), and the utilization of surgery has mirrored an increase in the use of magnetic resonance imaging (MRI).
MRI has been associated with a nocebic effect potentially due to alarming terminology. MRI reporting without a clinical knowledge of the patient can potentially contribute to invasive interventions to normalize any spinal defects.
Therefore, the aim of this paper was to assess the effect of such reporting on the perception of the condition of the spine, as well as pain and functional outcomes.
44 patients with chronic non-specific LBP were randomized to group A (n=21) who received a full factual explanation of the pathologies reported in their MRI, or Group B (n=23) who were reassured that their MRI was completely normal with only incidental and age-related findings. All patients had no significant pathologies on MRI.
Outcome measures used were severity of pain (VAS), pain self-efficacy questionnaire (PSEQ), and SF-12 to measure functional status. The groups were then compared at 6 weeks after similar conservative therapy.
For both the VAS and the PSEQ, the effect size between group A (factual reporting) and group B (reassurance) was large in favor of the reassurance group following the 6-week conservative care program. At 6 weeks the between-group effect size for VAS was 2.8499 and the PSEQ 2.998.
This study was a single-centre design and therefore may benefit from a larger multi-centre trial to replicate the results in a wider population and reduce observer bias.
The clinical implications of this paper are clear – the way in which MRI reports are described to patients appears to have a large effect on the outcomes at 6-weeks following a program of conservative care. The primary outcome measure of the PSEQ was double the minimal clinical important difference at 6 weeks.
For clinicians, helping patients to understand the meaning and implications of MRI reports can be a key aspect of good care. This can involve explanations of the terminology, expanding on patient concerns, and also highlighting the frequency of similar findings in asymptomatic populations. These findings also have to correlate with the clinical assessment and not just be taken in isolation, in line with a modern multifactorial understanding of painful spinal conditions.
Here’s what this review looks like in our May issue.
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