How I wish my VOMIT poster was no longer needed!

This recent study (Rajasekaran et al 2021) investigated the difference in patient outcomes when those with low back pain were randomized to receive different styles of MRI reporting. Some received “factual explanation of their MRI report”, and others “were reassured that the MRI findings showed normal changes” while avoiding potential catastrophizing terminologies.

It should come as no surprise that the patients who were simply given factual information regarding their MRI had…

  • Greater negative perception of their spinal condition
  • Greater catastrophization
  • Less improvement in their pain and functional scores

The VOMIT (Victim of Medical Imaging Technology) poster is freely available for you to print in 9 different languages. I wish the day would come when the VOMIT poster was not needed and that it was common sense to not instill needless fear into vulnerable patients with mostly useless MRI results.

You know what else can cause catastrophizing and delay recovery? PTs telling patients that they are weak and need strengthening. I have been guilty of saying that for the vast majority of my PT career but I am making a shift away from that. Telling patients that their “core is weak” hence causing their low back pain, not only lacks evidence, it may be harmful.

This paper (Powell et al 2021) described the same concept with respect to those with shoulder / rotator cuff related pain, where patients are frequently told by PTs, “Your shoulder is weak and you need to strengthen it”, which can leave patients feeling fragile.

I’m certainly not suggesting in any way that we should stop prescribing resisted exercises; I am however proposing that perhaps there is a better explanation as to why the resistive exercises we prescribe are effective. It may not be because patients become “stronger”, but perhaps due to more complex neurophysiological reasons.

As health care providers we must all strive to increase, not reduce our patients’ sense of wellness!

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