Why does the adverse effect of inappropriate MRI for LBP vary by geographic location? An exploratory analysis

Background Early magnetic resonance imaging (eMRI) for nonspecific low back pain (LBP) not adherent to clinical guidelines is linked with prolonged work disability. Although the prevalence of eMRI for occupational LBP varies substantially among states, it is unknown whether the risk of prolonged disability associated with eMRI varies according to individual and area-level characteristics. The aim was to explore whether the known risk of increased length of disability (LOD) associated with eMRI scanning not adherent to guidelines for occupational LBP varies according to patient and area-level characteristics, and the potential reasons for any observed variations. Methods A retrospective cohort of 59,360 LBP cases from 49 states, filed between 2002 and 2008, and examined LOD as the outcome. LBP cases with at least 1 day of work disability were identified by reviewing indemnity service records and medical bills using a comprehensive list of codes from the International Classification of Diseases, Ninth Edition (ICD-9) indicating LBP or nonspecific back pain, excluding medically complicated cases. Results We found significant between-state variations in the negative impact of eMRI on LOD ranging from 3.4 days in Tennessee to 14.8 days in New Hampshire. Higher negative impact of eMRI on LOD was mainly associated with female gender, state workers’ compensation (WC) policy not limiting initial treating provider choice, higher state orthopedic surgeon density, and lower state MRI facility density. Conclusion State WC policies regulating selection of healthcare provider and structural factors affecting quality of medical care modify the impact of eMRI not adherent to guidelines. Targeted healthcare and work disability prevention interventions may improve work disability outcomes in patients with occupational LBP.Other Information Published in: BMC Musculoskeletal Disorders License: http://creativecommons.org/licenses/by/4.0/See article on publisher's website: http://dx.doi.org/10.1186/s12891-019-2964-7</p

Incidence Rate of Fall-related Injuries per 100 Person-year by Age-Gender Groups from 2004 to 2013 in the U.S.

<p>Medically consulted fall-related injury episodes occurring in the previous three months among community-dwelling adults were identified in the National Health Interview Survey. We annualized the fall-related injury estimates and calculated rates of fall-related injuries per 100 Person-year by age and gender groups using population weights.</p

Number and Proportion of Community-dwelling Adults who Experienced One or More Falls in the Previous 12 Months and Number and Rate of Falls per 100 Person-Years by Age and Gender Groups.

<p>Number and Proportion of Community-dwelling Adults who Experienced One or More Falls in the Previous 12 Months and Number and Rate of Falls per 100 Person-Years by Age and Gender Groups.</p

Average and total lifetime cost (US $) of Annual Unintentional Fall-Related Injuries Resulting in Death, Hospitalization or an Emergency Department Visit in the U.S. by age-groups, 2010^*.

<p>Average and total lifetime cost (US $) of Annual Unintentional Fall-Related Injuries Resulting in Death, Hospitalization or an Emergency Department Visit in the U.S. by age-groups, 2010^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0150939#t004fn001" target="_blank">*</a>}.</p

Annual Average Fall-related injury^a types in thousands (000s) and their Proportion^b ^c by Age and Gender Groups.

<p>NHIS 2004–2013.</p

Number and Proportion of Community-dwelling Adults who Experienced a Fall-related Injury in the Previous 3 Months, Average Number of Fall-related Injuries in One Year and the Rate of Fall-related Injuries per 100 Person-Years in the U.S. NHIS 2004–2013.

<p>Number and Proportion of Community-dwelling Adults who Experienced a Fall-related Injury in the Previous 3 Months, Average Number of Fall-related Injuries in One Year and the Rate of Fall-related Injuries per 100 Person-Years in the U.S. NHIS 2004–2013.</p