Importance: In contrast to the recommendations for younger adults, many guidelines allow for older adults with back pain to undergo imaging without waiting 4 to 6 weeks. However, early imaging may precipitate interventions that do not improve outcomes.
Objective: To compare function and pain at the 12-month follow-up visit among older adults who received early imaging with those who did not receive early imaging after a new primary care visit for back pain without radiculopathy.
Design, Setting, And Participants: Prospective cohort of 5239 patients 65 years or older with a new primary care visit for back pain (2011-2013) in 3 US health care systems. We matched controls 1:1 using propensity score matching of demographic and clinical characteristics, including diagnosis, pain severity, pain duration, functional status, and prior resource use.
Exposures: Diagnostic imaging (plain films, computed tomography [CT], magnetic resonance imaging [MRI]) of the lumbar or thoracic spine within 6 weeks of the index visit.
Primary Outcome: back or leg pain-related disability measured by the modified Roland-Morris Disability Questionnaire (score range, 0-24; higher scores indicate greater disability) 12 months after enrollment.
Results: Among the 5239 patients, 1174 had early radiographs and 349 had early MRI/CT. At 12 months, neither the early radiograph group nor the early MRI/CT group differed significantly from controls on the disability questionnaire. The mean score for patients who underwent early radiography was 8.54 vs 8.74 among the control group (difference, -0.10 [95% CI, -0.71 to 0.50]; mixed model, P = .36). The mean score for the early MRI/CT group was 9.81 vs 10.50 for the control group (difference,-0.51 [-1.62 to 0.60]; mixed model, P = .18).
Conclusions And Relevance: Among older adults with a new primary care visit for back pain, early imaging was not associated with better 1-year outcomes. The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1001/jama.2015.1871 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
ASO Visual Abstract: Defining and Predicting Early Recurrence for Optimal Treatment Strategies in Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Cancer--An International Multicenter Study.
Ann Surg Oncol
January 2025
Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center and St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
3D CT to 2D X-ray image registration for improved visualization of tibial vessels in endovascular procedures.
Int J Comput Assist Radiol Surg
January 2025
Department of Medical Biophysics, University of Toronto, Toronto, Canada.
Purpose: During endovascular revascularization interventions for peripheral arterial disease, the standard modality of X-ray fluoroscopy (XRF) used for image guidance is limited in visualizing distal segments of infrapopliteal vessels. To enhance visualization of arteries, an image registration technique was developed to align pre-acquired computed tomography (CT) angiography images and to create fusion images highlighting arteries of interest.
Methods: X-ray image metadata capturing the position of the X-ray gantry initializes a multiscale iterative optimization process, which uses a local-variance masked normalized cross-correlation loss to rigidly align a digitally reconstructed radiograph (DRR) of the CT dataset with the target X-ray, using the edges of the fibula and tibia as the basis for alignment.
Successful thoracoscopic-assisted resection of a functional paraganglioma in the mediastinum with extracorporeal circulation: a case report.
J Cardiothorac Surg
January 2025
Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, P. R. China.
Background: Paragangliomas are rare neoplasms arising from extra-adrenal chromaffin cells, with mediastinal paragangliomas representing an exceptionally rare subset. This report details the surgical management of a complex mediastinal paraganglioma case, presenting with refractory hypertension and invasion of critical surrounding structures. A comprehensive review of the current literature is included to underscore existing cases, enhance clinical awareness, and share our insights and experience in the diagnosis and treatment of this challenging condition.
View Article and Find Full Text PDFLong-term outcomes of Türkiye's first population-based mammography screening program: a decade of breast cancer detection and survival analysis in Bahçeşehir.
BMC Womens Health
January 2025
Department of General Surgery, İstanbul Faculty of Medicine, İstanbul University, İstanbul, 34093, Türkiye.
Background: The Bahçeşehir population-based mammography screening program (BMSP) is an example of Türkiye's first population-based screening program. This study aims to reveal the successful implementation of population-based secreening program in one of the low- and middle-income countries, Türkiye and long-term results of patients diagnosed with breast cancer during BMSP.
Methods: This study was conducted between 2009 and 2019, in the Bahçeşehir county of Istanbul.
Effects of intermittent theta burst stimulation on cognitive and swallowing function in patients with MCI and dysphagia risk: a randomized controlled trial.
BMC Geriatr
January 2025
Department of Rehabilitation Medicine (Rehabilitation Center), Qilu Hospital of Shandong University, No. 107, Wenhuaxi Road, Jinan , Shandong, 250012, China.
Background: Mild cognitive impairment (MCI) is a high-risk factor for dementia and dysphagia; therefore, early intervention is vital. The effectiveness of intermittent theta burst stimulation (iTBS) targeting the right dorsal lateral prefrontal cortex (rDLPFC) remains unclear.
Methods: Thirty-six participants with MCI were randomly allocated to receive real (n = 18) or sham (n = 18) iTBS.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!