“Gleaning a lot from the history and physical exam,” and “reasonably confident without imaging”: a qualitative study of primary care clinicians' management of patients with low back pain
Abstract Background Routine seeking of imaging for patients with low back pain is not concordant with the evidence-based recommendation that imaging is rarely of diagnostic value. Inappropriate imaging is a waste of resources and can lead to undesirable downstream effects for individuals and health...
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| Format: | Article |
| Language: | English |
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BMC
2025-02-01
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| Series: | BMC Primary Care |
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| Online Access: | https://doi.org/10.1186/s12875-025-02726-z |
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| author | Lynn Haslam-Larmer Kathleen E. Norman Andrea M. Patey Isabella M. Thomas Michael E. Green Jeremy M. Grimshaw Jill A. Hayden Jan Hartvigsen Noah M. Ivers Hazel Jenkins Simon D. French |
| author_facet | Lynn Haslam-Larmer Kathleen E. Norman Andrea M. Patey Isabella M. Thomas Michael E. Green Jeremy M. Grimshaw Jill A. Hayden Jan Hartvigsen Noah M. Ivers Hazel Jenkins Simon D. French |
| author_sort | Lynn Haslam-Larmer |
| collection | DOAJ |
| description | Abstract Background Routine seeking of imaging for patients with low back pain is not concordant with the evidence-based recommendation that imaging is rarely of diagnostic value. Inappropriate imaging is a waste of resources and can lead to undesirable downstream effects for individuals and health systems. To develop effective strategies to reduce unwarranted referrals for imaging in primary care, we must understand the drivers for, and barriers to, guideline-adherent practice. We explored clinicians’ views to identify the dominant influences on clinicians as they choose to pursue, or avoid, imaging for their patients with low back pain. Methods We interviewed a purposeful sample of 47 primary care clinicians (14 physiotherapists, 18 chiropractors, 15 physicians) throughout Ontario, Canada, with a guide based on the Theoretical Domains Framework (TDF). We investigated clinicians’ views about their use of imaging in the management of low back pain. Interviews were recorded and transcribed verbatim. We analysed transcripts, then identified themes within TDF domains. Results Most clinicians reported that, for most clinical encounters, they adhered to guideline recommendations about imaging. Many clinicians across disciplines expressed the following themes: (1) imaging may result in an incidental finding or otherwise cause harm to patients, and drive up health system costs (TDF domain Beliefs about consequences); (2) clinicians were confident in their abilities to diagnose, to explain to patients the rationale for not recommending imaging, and to respond to their needs (domains Beliefs about capabilities; Skills). Many clinicians identified that patients occasionally want the validation that imaging provides (domain Social influences). Some clinicians described the value of imaging to corroborate a diagnosis (domain Beliefs about consequences). Conclusions This study is the first to examine influences on imaging behaviours of a large interprofessional sample of primary care clinicians in Canada. Even among knowledgeable, skilled, confident clinicians who reported mostly adhering to guideline recommendations, there are potential influences on deviating from guideline-adherent care. |
| format | Article |
| id | doaj-art-ee65453d7ccb431f8e26deca74c41c86 |
| institution | Kabale University |
| issn | 2731-4553 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Primary Care |
| spelling | doaj-art-ee65453d7ccb431f8e26deca74c41c862025-02-09T12:48:32ZengBMCBMC Primary Care2731-45532025-02-0126111710.1186/s12875-025-02726-z“Gleaning a lot from the history and physical exam,” and “reasonably confident without imaging”: a qualitative study of primary care clinicians' management of patients with low back painLynn Haslam-Larmer0Kathleen E. Norman1Andrea M. Patey2Isabella M. Thomas3Michael E. Green4Jeremy M. Grimshaw5Jill A. Hayden6Jan Hartvigsen7Noah M. Ivers8Hazel Jenkins9Simon D. French10Queen’s UniversityQueen’s UniversityDepartment of Medicine, Quality and Safety, IWK HealthQueen’s UniversityQueen’s UniversityOttawa Hospital Research InstituteDalhousie UniversityUniversity of Southern DenmarkUniversity of TorontoMacquarie UniversityQueen’s UniversityAbstract Background Routine seeking of imaging for patients with low back pain is not concordant with the evidence-based recommendation that imaging is rarely of diagnostic value. Inappropriate imaging is a waste of resources and can lead to undesirable downstream effects for individuals and health systems. To develop effective strategies to reduce unwarranted referrals for imaging in primary care, we must understand the drivers for, and barriers to, guideline-adherent practice. We explored clinicians’ views to identify the dominant influences on clinicians as they choose to pursue, or avoid, imaging for their patients with low back pain. Methods We interviewed a purposeful sample of 47 primary care clinicians (14 physiotherapists, 18 chiropractors, 15 physicians) throughout Ontario, Canada, with a guide based on the Theoretical Domains Framework (TDF). We investigated clinicians’ views about their use of imaging in the management of low back pain. Interviews were recorded and transcribed verbatim. We analysed transcripts, then identified themes within TDF domains. Results Most clinicians reported that, for most clinical encounters, they adhered to guideline recommendations about imaging. Many clinicians across disciplines expressed the following themes: (1) imaging may result in an incidental finding or otherwise cause harm to patients, and drive up health system costs (TDF domain Beliefs about consequences); (2) clinicians were confident in their abilities to diagnose, to explain to patients the rationale for not recommending imaging, and to respond to their needs (domains Beliefs about capabilities; Skills). Many clinicians identified that patients occasionally want the validation that imaging provides (domain Social influences). Some clinicians described the value of imaging to corroborate a diagnosis (domain Beliefs about consequences). Conclusions This study is the first to examine influences on imaging behaviours of a large interprofessional sample of primary care clinicians in Canada. Even among knowledgeable, skilled, confident clinicians who reported mostly adhering to guideline recommendations, there are potential influences on deviating from guideline-adherent care.https://doi.org/10.1186/s12875-025-02726-zLow back painGuidelinesImagingTheoretical Domains Framework |
| spellingShingle | Lynn Haslam-Larmer Kathleen E. Norman Andrea M. Patey Isabella M. Thomas Michael E. Green Jeremy M. Grimshaw Jill A. Hayden Jan Hartvigsen Noah M. Ivers Hazel Jenkins Simon D. French “Gleaning a lot from the history and physical exam,” and “reasonably confident without imaging”: a qualitative study of primary care clinicians' management of patients with low back pain BMC Primary Care Low back pain Guidelines Imaging Theoretical Domains Framework |
| title | “Gleaning a lot from the history and physical exam,” and “reasonably confident without imaging”: a qualitative study of primary care clinicians' management of patients with low back pain |
| title_full | “Gleaning a lot from the history and physical exam,” and “reasonably confident without imaging”: a qualitative study of primary care clinicians' management of patients with low back pain |
| title_fullStr | “Gleaning a lot from the history and physical exam,” and “reasonably confident without imaging”: a qualitative study of primary care clinicians' management of patients with low back pain |
| title_full_unstemmed | “Gleaning a lot from the history and physical exam,” and “reasonably confident without imaging”: a qualitative study of primary care clinicians' management of patients with low back pain |
| title_short | “Gleaning a lot from the history and physical exam,” and “reasonably confident without imaging”: a qualitative study of primary care clinicians' management of patients with low back pain |
| title_sort | gleaning a lot from the history and physical exam and reasonably confident without imaging a qualitative study of primary care clinicians management of patients with low back pain |
| topic | Low back pain Guidelines Imaging Theoretical Domains Framework |
| url | https://doi.org/10.1186/s12875-025-02726-z |
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