Early MRI results in LONGER Disability!
Reference:Graves JM, et al Early Imaging for Acute Low Back Pain: One-year Health and Disability Outcomes Among Washington State Workers. Spine. 2012 Mar 13.
This study looked at the effects of early MRI on patients with work related low back injury (LBI) in the state of Washington.
It is often assumed that early MRI for LBI is associated with better health outcomes. After all the sooner you can reveal what exactly the problem is, the sooner you can treat it and make it get better, right?
Of the 1,200 workers with LBI receiving MRI, 78% were diagnosed as having a local “lumbar sprain” and 22% were diagnosed as having “lumbar radiculopathy”.
Since this was not a randomized trial, the researchers adjusted for covariates such as baseline pain, function, and psychosocial variables.
Result #1: For workers with “lumbar radiculopathy”, early MRI did not influence disability rates at 1 year. Early MRI neither helped nor delayed recovery.
Result #2: For workers with “lumbar sprain”, early MRI was associated with a 2-fold INCREASE in the likelihood of work disability at 1 year.
Result #3: For both ?sprain? and ?radiculopathy? groups, early MRI was associated with longer disability duration (p<0.001).
Conclusion: For workers with LBI, early MRI is NOT associated with better health outcomes BUT is in fact associated with increased disability duration.
Personal Comment: I know it’s easy to complain about the long waiting times for getting an MRI in Canada. A Canadian patient with low back pain is likely to wait several months before getting an MRI, meanwhile in the USA, patients can get an MRI within 48 hours.
Knowing this study, I suggest that you consider that long Canadian waiting period a true blessing!! (Certainly waiting times in other areas of healthcare are not a blessing, but this is not the place to complain about that!)
However, if a patient has progressive neural signs and perhaps red flags, in my experience, the MRI is usually expedited, as it should be!
Posted on: October 06, 2012
Categories: Lumbar Spine