背景:在下腰痛(LBP)管理中使用诊断成像通常是不合适的,尽管临床实践指南提出了建议。对影响成像临床决策(CDM)过程的因素的了解有限。
目的:探讨LBP患者影像学CDM影响因素的文献,并考虑这些发现如何用于减少LBP治疗中影像学的不当使用。
方法:范围审查。
方法:本审查遵循了用于范围审查的系统审查扩展的首选报告项目。在Medline进行了数字搜索,护理和相关健康文献的累积指数,Scopus,以及2010年1月至2023年之间发表的合格研究的Cochrane中央对照试验登记册。提取数据报告对成像CDM的影响。然后通过归纳过程对数据进行分析,将影响因素分为几类。
结果:筛选后,35项研究(5项定性研究和30项定量研究)纳入审查,报告了影响成像CDM的因素。开发了三类:临床特征(如危险信号,疼痛,和神经功能缺损),不可改变的因素(如年龄、性别,和种族)和可修改的因素(例如对后果和临床实践的信念)。大多数研究报告了不可改变的因素。
结论:这项范围审查的结果挑战了成像CDM纯粹基于临床病史和客观发现的看法。临床特征之间存在复杂的相互作用,患者和临床医生特征,信仰,和环境。在设计策略以解决不适当的成像行为时,应考虑这些发现。
BACKGROUND: The use of diagnostic imaging in low back pain (LBP) management is often inappropriate, despite recommendations from clinical practice guidelines. There is a limited understanding of factors that influence the imaging clinical decision-making (CDM) process.
OBJECTIVE: Explore the literature on factors influencing imaging CDM for people with LBP and consider how these findings could be used to reduce inappropriate use of imaging in LBP management.
METHODS: Scoping
review.
METHODS: This
review followed the Preferred Reporting Items for Systematic
Review extension for scoping reviews. A digital search was conducted in Medline, the Cumulative Index of Nursing and Allied Health Literature, Scopus, and the Cochrane Central Register of Controlled Trials for eligible studies published between January 2010-2023. Data reporting influences on imaging CDM were extracted. Data were then analysed through an inductive process to group the influencing factors into categories.
RESULTS: After screening, 35 studies (5 qualitative and 30 quantitative) were included in the
review, which reported factors influencing imaging CDM. Three categories were developed: clinical features (such as red flags, pain, and neurological deficit), non-modifiable factors (such as age, sex, and ethnicity) and modifiable factors (such as beliefs about consequences and clinical practice). Most studies reported non-modifiable factors.
CONCLUSIONS: The results of this scoping
review challenge the perception that imaging CDM is purely based on clinical history and objective findings. There is a complex interplay between clinical features, patient and clinician characteristics, beliefs, and environment. These findings should be considered when designing strategies to address inappropriate imaging behaviour.