Patient characteristics and patterns of use for lumbar spine radiographs -Results from the Veterans Health Study

Study Design. Longitudinal data from the Veterans Health Study, an observat ional study of male patients receiving Veterans Administration ambulatory c are, were analyzed. Objective. To identify patient characteristics that predict different patte rns in the use of lumbar spine radiographs. Summary and Background Data. in this study, 401 patients with low back pain receiving ambulatory care services in four Veterans Administration outpati ent clinics in the greater Boston area were followed for 12 months. Methods. Participants were mailed the Medical Outcome Study Short Form Heal th Survey and participated in scheduled interviews that included the comple tion of a low back questionnaire, a comorbidity index, and a straight leg r aising test. Four groups of patients were defined according to the patterns of use for lumbar spine radiographs: prior use, repeat use, no use, and ne w use of lumbar spine radiographs. These groups were compared in terms of s ociodemographics, comorbid conditions, low back pain intensity, radiating l eg pain, straight leg raising, Medical Outcome Study Short Form Health Surv ey scores, and low back disability days. Results. The patients with new lumbar spine radiographs showed worse physic al and psychological distress than the participants in the other three grou ps. In contrast, the patients with no lumbar spine radiographs reported min or physical impairment. Compared with patients who had no repeat radiograph s, patients with repeat lumbar spine radiographs had similar scores on phys ical health, hut they showed worse scores of mental health. Conclusions. Both physical and psychological factors contribute to having n ew radiographic examinations, whereas psychological factors have increased importance in the repeat use of roentgenographic examinations. Repeat radio graphs appear to be overused, judging by the severity of physical impairmen t as measured by low back pain intensity, the Medical OutcomeStudy Short Fo rm Health Survey, and disability days.