Table 3 The relationship between eMRI and length of disability among low back pain cases

Shraim 2019 [13]

1

“To explore whether the known risk of increased 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.”

The eMRI group had a longer mean LOD by 9.4 days (95% CI¹ 8.5, 10.2) compared to the no eMRI group.

Age, gender, tenure, average weekly wage, industry, injury severity, morphine equivalent amount in first 15 days of seeking medical care, lumbar spine surgery, litigation status, neighborhood median household income, state physician density, state orthopedic surgeons’ density, state MRI facility rate, and state workers’ compensation policies on wage replacement rate, waiting period, retroactive period, treating provider choice and change.

“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.”

Shraim 2017 [7]

1

“To determine if SE characteristics of claimants’ geographic context were associated with WC benefits including intensity of medical care (as reflected by medical expenses) and length of time absent from work for acute uncomplicated LBP, after controlling for individual and state characteristics.”

The eMRI group had a longer mean LOD by 13.3 days (95% CI 11.8, 14.8) than the no eMRI group.

Age, gender, average weekly wage, industry type, injury severity, early opioid/100 mg MEA in first 15 days, lumbar spine surgery, claim litigation status, neighborhood median household income, and state variables (state WC policies (wage replacement rate, waiting period, retroactive period, treating provider choice status, treating provider change status, state medical fee schedule status) unemployment rate, MRI facility rate, state physician density, orthopedic surgeons’ density).

“Regional SE disparities in medical costs and LOD occur even when health insurance, health care availability, and indemnity benefits are similar. Results suggest opportunities to improve care and disability outcomes through targeted health care and disability interventions.”

Shraim 2015 [6]

1

“To examine the impact of state WC policies regarding wage replacement and medical benefits on medical costs and LOD in workers with LBP.”

The eMRI group had a longer mean LOD by 13.7 days (95% CI 13.0, 14.5) than the no eMRI group.

Age, gender, average weekly wage, industry type, injury severity, early opioid/100 mg MEA in first 15 days, lumbar spine surgery, claim litigation status, work-live in same state status, neighborhood variables (median household income, rural population percentage, white population percentage, education attainment (percentage less than some college education), and state variables (state WC policies, wage replacement rate, waiting period, retroactive period, treating provider choice status, treating provider change status, state medical fee schedule status) percentage of population below 100% poverty, Gini coefficient percentage, unemployment rate, disabled workers receiving social security disability insurance).

“WC policies about wage replacement and medical treatment appear to be associated with WC LBP outcomes and might represent opportunities to improve LOD and reduce medical costs in occupational LBP.”

Webster 2013 [11]

2

“To determine the effect of early (receipt ≤30 d post-onset) magnetic resonance imaging (MRI) on disability and medical cost outcomes in patients with acute, disabling, work-related low back pain (LBP) with and without radiculopathy.”

At two-year follow-up, the mean LOD was 165 days (95% CI 128.5, 201.5) and 44.4 days (95% CI 37.5, 51.4) in the eMRI group and the no eMRI group, respectively. The eMRI group had a lower hazard ratio for going off disability by 0.32 (95% CI 0.24, 0.43) compared to the no eMRI group.

Age, sex, job tenure, jurisdiction state, morphine equivalent amount in first 15 days, time to first lumbar MRI, and average weekly medical costs pre-MRI.

“Early MRI without indication has a strong iatrogenic effect in acute LBP, regardless of radiculopathy status. Providers and patients should be made aware that when early MRI is not indicated, it provides no benefits, and worse outcomes are likely.”

Graves 2012 [10]

1

“To evaluate the association of early imaging and health and disability status 1 year following acute low back injury, among a population-based sample of Washington State workers’ compensation claimants.”

At one-year follow-up, the mean LOD was 163.5 days (standard deviation (SD) = 144.6) and 42.6 days (SD = 86.6) in the eMRI group and the no eMRI group, respectively.

The eMRI group had a higher hazard ratio for work disability by 2.03 (95% CI 1.33, 3.11) than the no eMRI group.

Age, sex, race/ethnicity, education level, household income, marital status, body mass index, health status in year before injury, health status at baseline interview, baseline pain, Roland-Morris disability questionnaire scores, pain intensity, quality of life (role physical, physical functioning, and mental health scores), catastrophizing, work-fear avoidance, offered job accommodation for disability, previous LBP status, job satisfaction, industry, physical demands at work, and type of first medical visit.

“Among workers with LBP, early MRI is not associated with better health outcomes and is associated with increased likelihood of disability and its duration. These associations warrant further testing in a randomized controlled trial. Our findings suggest that adherence to evidence-based guidelines is an important factor in ensuring that workers receive the highest quality care for occupational injuries.”

Webster 2010 [37]

2

“To examine early magnetic resonance imaging (MRI) utilization for workers compensation cases with acute, disabling low backpain and further, to examine low or high propensity to undergo early MRI with disability duration, medical costs, and surgery.”

At two-year follow-up, the mean LOD was 133.6 days (95% CI 120.5, 146.7) and 22.9 days (95% CI 19.5, 26.2) in the eMRI group and the no eMRI group, respectively. To control for potential MRI indication bias, the propensity of belonging to the eMRI group was computed on the basis of demographic and severity indicators with adjustment for potential residual confounding of covariates. As compared to the eMRI (low propensity): The no MRI (low propensity) group had a hazard ratio of 3.0 (95% CI 2.6, 3.4) to go off disability. The no MRI (high propensity) group had a hazard ratio of 2.9 (95% CI 2.3, 3.5) to go off disability

Age, gender, job tenure, pre-MRI medical costs and disability, days to first MRI, early opioid use and MEA dose, maximum severity pre-MRI, and state of residence

“The majority of cases had no early MRI indications. Results suggest that iatrogenic effects of early MRI are worse disability and increased medical costs and surgery, unrelated to severity.”

Mahmud 2000 [12]

1

“To determine whether health care utilization and the physician’s initial management of work-related LBP were associated with disability duration.”

The no eMRI group had a higher risk ratio for going off disability by 2.91 (95% CI 1.45, 5.84) compared to the eMRI group.

Gender, physical job, demand, main care provider (primary care or specialist), main care setting (private clinic, urgent care or others) specialist referral, number of physician visit, multiple MD care status, clinical severity at initial presentation, diagnostic imaging status (x-ray, CT, and ultrasound status), opioid prescription status, and other therapeutic intervention (bed rest, back stretch, and back exercise status)

“The nature of the association

between these initial clinical management aspects and LBP disability duration merits further exploration.”