{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:18:29Z","timestamp":1791364709159,"version":"4.3.1"},"reference-count":27,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2017,12,6]],"date-time":"2017-12-06T00:00:00Z","timestamp":1512518400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Royal Adelaide Hospital Clinical Research Grants"},{"name":"Royal Adelaide Hospital Research Foundation Dawes Scholarship"},{"name":"NHMRC (Principal Research Fellowship)","award":["1061279"],"award-info":[{"award-number":["1061279"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low back pain clinical practice guidelines consistently recommend against the routine ordering of spinal imaging; however, imaging is frequently requested in primary care, without evidence of benefit. Imaging reports frequently identify degenerative features which are likely to be interpreted as \u2018abnormal\u2019, despite their high prevalence in symptom-free individuals. The aim of this study was to investigate whether post-imaging back-related perceptions are influenced by providing prior information about normal findings, and to compare the effect of receiving imaging results with best practice care (without imaging). The impact of introducing novel, \u2018enhanced\u2019 reporting strategies was also explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study was a simulated-patient, randomised, multiple-arm experiment. Patient scenarios were presented to volunteer healthy adult participants via an online survey. In the scenarios, \u2018virtual\u2019 patients with low back pain were randomised to one of three groups. Group 1 received imaging and was pre-informed about normal findings. Group 2 received imaging (without pre-information). Group 3 received best practice care: quality information without imaging. Group 1 was further divided to receive either a standard report, or an \u2018enhanced\u2019 report (containing altered terminology and epidemiological information). The primary outcome was back-related perceptions (BRP), a composite score derived from three numeric rating scale scores exploring perceptions of spinal condition, recovery concerns and planned activity. The secondary outcomes were satisfaction and kinesiophobia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Full data were available from 660 participants (68% female). Analysis of covariance revealed a significant effect of group after controlling for baseline BRP scores $(F(2,74)=10.4,p\\lt 0.001,{\\eta }_{p}^{2}=.04)$. Pairwise comparisons indicated that receiving best practice care resulted in more positive BRPs than receiving imaging results, and receiving prior information about normal findings had no impact. Enhanced reporting strategies also positively impacted BRPs $(F(1,275)=13.06,p\\lt 0.001,{\\eta }_{p}^{2}=.05)$. Significant relationships between group allocation and both satisfaction $(F(2,553)=7.5,p=0.001,{\\eta }_{p}^{2}=.03)$ and kinaesiophobia $(F(2,553)=3.0,p=0.050,{\\eta }_{p}^{2}=.01)$ were found, with statistically significant pairwise comparisions again in favour of best-practice care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Intervention strategies such as enhanced reporting methods and the provision of quality information (without imaging) have the potential to improve the outcome of patients with recent-onset LBP and should be further considered by primary care providers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.4151","type":"journal-article","created":{"date-parts":[[2017,12,6]],"date-time":"2017-12-06T04:14:09Z","timestamp":1512533649000},"page":"e4151","source":"Crossref","is-referenced-by-count":35,"title":["The impact of choosing words carefully: an online investigation into imaging reporting strategies and best practice care for low back pain"],"prefix":"10.7717","volume":"5","author":[{"given":"Emma L.","family":"Karran","sequence":"first","affiliation":[{"name":"School of Health Sciences, University of South Australia, Adelaide, SA, Australia"},{"name":"Royal Adelaide Hospital, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmin","family":"Medalian","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of South Australia, Adelaide, SA, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan L.","family":"Hillier","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of South Australia, Adelaide, SA, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Lorimer","family":"Moseley","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of South Australia, Adelaide, SA, Australia"},{"name":"Neuroscience Research Australia, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4443","published-online":{"date-parts":[[2017,12,6]]},"reference":[{"key":"10.7717\/peerj.4151\/ref-1","doi-asserted-by":"crossref","first-page":"811","DOI":"10.3174\/ajnr.A4173","article-title":"Systematic literature review of imaging features of spinal degeneration in asymptomatic populations","volume":"36","author":"Brinjikji","year":"2014","journal-title":"American Journal of Neuroradiology"},{"key":"10.7717\/peerj.4151\/ref-2","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1016\/S0140-6736(09)60172-0","article-title":"Imaging strategies for low-back pain: systematic review and meta-analysis","volume":"373","author":"Chou","year":"2009","journal-title":"The Lancet"},{"key":"10.7717\/peerj.4151\/ref-3","doi-asserted-by":"publisher","first-page":"181","DOI":"10.7326\/0003-4819-154-3-201102010-00008","article-title":"Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians","volume":"154","author":"Chou","year":"2011","journal-title":"Annals of Internal Medicine"},{"key":"10.7717\/peerj.4151\/ref-4","volume-title":"Statistical power analysis for the behavioral sciences","author":"Cohen","year":"1998"},{"key":"10.7717\/peerj.4151\/ref-5","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1016\/j.spinee.2013.10.031","article-title":"A systematic review of diagnostic imaging use for low back pain in the United States","volume":"14","author":"Dagenais","year":"2014","journal-title":"The Spine Journal"},{"key":"10.7717\/peerj.4151\/ref-6","doi-asserted-by":"publisher","first-page":"e005251","DOI":"10.1136\/bmjopen-2014-005251","article-title":"The development and exploratory analysis of the back pain attitudes questionnaire (Back-PAQ)","volume":"4","author":"Darlow","year":"2014","journal-title":"BMJ Open"},{"key":"10.7717\/peerj.4151\/ref-7","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1037\/a0026502","article-title":"The psychological impact of test results following diagnostic coronary CT angiography","volume":"31","author":"Devcich","year":"2012","journal-title":"Health Psychology"},{"key":"10.7717\/peerj.4151\/ref-8","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1001\/jamainternmed.2013.3804","article-title":"Overuse of magnetic resonance imaging","volume":"173","author":"Emery","year":"2013","journal-title":"JAMA Internal Medicine"},{"key":"10.7717\/peerj.4151\/ref-9","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/S0022-3999(96)00164-X","article-title":"Reappraising reassurance\u2014the role of investigations","volume":"41","author":"Howard","year":"1996","journal-title":"Journal of Psychosomatic Research"},{"key":"10.7717\/peerj.4151\/ref-10","doi-asserted-by":"publisher","first-page":"1558","DOI":"10.1136\/jnnp.2004.057851","article-title":"Are investigations anxiolytic or anxiogenic? A randomised controlled trial of neuroimaging to provide reassurance in chronic daily headache","volume":"76","author":"Howard","year":"2005","journal-title":"Journal of Neurology, Neurosurgery & Psychiatry"},{"key":"10.7717\/peerj.4151\/ref-11","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.cct.2015.10.003","article-title":"Lumbar imaging with reporting of epidemiology (LIRE)\u2014protocol for a pragmatic cluster randomized trial","volume":"45","author":"Jarvik","year":"2015","journal-title":"Contemporary Clinical Trials"},{"key":"10.7717\/peerj.4151\/ref-12","doi-asserted-by":"publisher","first-page":"2075","DOI":"10.1007\/s00586-010-1502-y","article-title":"An updated overview of clinical guidelines for the management of non-specific low back pain in primary care","volume":"19","author":"Koes","year":"2010","journal-title":"European Spine Journal"},{"key":"10.7717\/peerj.4151\/ref-13","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1016\/S0140-6736(16)30970-9","article-title":"Non-specific low back pain","volume":"389","author":"Maher","year":"2016","journal-title":"The Lancet"},{"key":"10.7717\/peerj.4151\/ref-14","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1148\/radiol.11110618","article-title":"Lumbar MR imaging and reporting epidemiology: do epidemiologic data in reports affect clinical management?","volume":"262","author":"McCullough","year":"2012","journal-title":"Radiology"},{"key":"10.7717\/peerj.4151\/ref-15","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/j.jpain.2015.05.005","article-title":"Fifteen years of explaining pain: the past, present, and future","volume":"16","author":"Moseley","year":"2015","journal-title":"The Journal of Pain"},{"key":"10.7717\/peerj.4151\/ref-16","volume-title":"Low back pain and sciatica in over 16s: assessment and management","author":"(NICE) National Guideline Centre (UK)","year":"2016"},{"key":"10.7717\/peerj.4151\/ref-17","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1136\/bmj.39093.464190.55","article-title":"Effect of providing information about normal test results on patients\u2019 reassurance: randomised controlled trial","volume":"334","author":"Petrie","year":"2007","journal-title":"BMJ"},{"key":"10.7717\/peerj.4151\/ref-18","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/S0140-6736(97)11499-4","article-title":"Should radiologists change the way they report plain radiography of the spine?","volume":"352","author":"Roland","year":"1998","journal-title":"The Lancet"},{"key":"10.7717\/peerj.4151\/ref-19","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1001\/jamainternmed.2013.2762","article-title":"Reassurance after diagnostic testing with a low pretest probability of serious disease: systematic review and meta-analysis","volume":"173","author":"Rolfe","year":"2013","journal-title":"JAMA Internal Medicine"},{"key":"10.7717\/peerj.4151\/ref-20","doi-asserted-by":"publisher","first-page":"1866","DOI":"10.1001\/jamainternmed.2016.6364","article-title":"Clinicians\u2019 perceptions of barriers to avoiding inappropriate imaging for low back pain\u2014knowing is not enough","volume":"176","author":"Sears","year":"2016","journal-title":"JAMA Internal Medicine"},{"key":"10.7717\/peerj.4151\/ref-21","doi-asserted-by":"publisher","first-page":"E1120","DOI":"10.1097\/BRS.0b013e3181e089a9","article-title":"Explanatory and diagnostic labels and perceived prognosis in chronic low back pain","volume":"35","author":"Sloan","year":"2010","journal-title":"Spine"},{"key":"10.7717\/peerj.4151\/ref-22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00586-017-5099-2","article-title":"National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy","author":"Stochkendahl","year":"2017","journal-title":"European Spine Journal"},{"key":"10.7717\/peerj.4151\/ref-23","doi-asserted-by":"publisher","first-page":"970","DOI":"10.1016\/j.jpain.2012.07.001","article-title":"Psychometric properties of the tampa scale for Kinesiophobia-11 (TSK-11)","volume":"13","author":"Tkachuk","year":"2012","journal-title":"The Journal of Pain"},{"key":"10.7717\/peerj.4151\/ref-24","article-title":"Evidence-informed primary care management of low back pain: clinical practice guideline. Edmonton, AB","author":"(TOP) Toward Optimized Practice","year":"2015"},{"key":"10.7717\/peerj.4151\/ref-25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.bjpt.2016.12.007","article-title":"Reassurance for patients with non-specific conditions\u2014a user\u2019s guide","volume":"21","author":"Traeger","year":"2017","journal-title":"Brazilian Journal of Physical Therapy"},{"key":"10.7717\/peerj.4151\/ref-26","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1001\/archinternmed.2009.507","article-title":"Low back pain and best practice care: a survey of general practice physicians","volume":"170","author":"Williams","year":"2010","journal-title":"Archives of Internal Medicine"},{"key":"10.7717\/peerj.4151\/ref-27","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.pain.2005.05.029","article-title":"Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia","volume":"117","author":"Woby","year":"2005","journal-title":"Pain"}],"container-title":["PeerJ"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/peerj.com\/articles\/4151.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/4151.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/4151.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/4151.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2017,12,6]],"date-time":"2017-12-06T04:14:21Z","timestamp":1512533661000},"score":1,"resource":{"primary":{"URL":"https:\/\/peerj.com\/articles\/4151"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,6]]},"references-count":27,"alternative-id":["10.7717\/peerj.4151"],"URL":"https:\/\/doi.org\/10.7717\/peerj.4151","archive":["CLOCKSS","LOCKSS","Portico"],"relation":{"has-review":[{"id-type":"doi","id":"10.7287\/peerj.4151v0.1\/reviews\/1","asserted-by":"object"},{"id-type":"doi","id":"10.7287\/peerj.4151v0.2\/reviews\/1","asserted-by":"object"},{"id-type":"doi","id":"10.7287\/peerj.4151v0.1\/reviews\/2","asserted-by":"object"}]},"ISSN":["2167-8359"],"issn-type":[{"value":"2167-8359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,6]]},"article-number":"e4151"}}