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

Key Points

1. MRIs can lead to greater healthcare utilization but without improved outcomes.

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BACKGROUND & 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). Despite comparable outcomes at one year (1), use of MRI over x-ray to assess LBP has been shown to result in three times the number of spine surgeries. Furthermore, patients who do not receive an MRI do as well as those who do receive one in both the short and long-term (2).

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. MRIs negative influence on patients has not been formally investigated. Therefore, the aim of this paper was to:

• Study the effect of routine MRI reports on the perception of the patient and treatment outcome.
• Devise a clinical method of MRI reporting avoiding words and phrases that could cause fear and catastrophization in patients.
• Carry out a blinded study to assess the effect of such reporting on the perception of the condition of the spine and decision-making.

Use of MRI over x-ray to assess LBP has been shown to result in three times the number of spine surgeries.

The way in which MRI reports are described to patients appears to have a large effect on outcomes.

METHODS

The study was conducted in three phases:

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