Tue Secher Jensen

Background: Low back pain (LBP) is the leading cause of disability worldwide. Despite guidelines advising against routine imaging, a significant proportion of patients are referred for lumbar spine magnetic resonance imaging (MRI) without an appropriate indication. This study aims to assess the impact of the intervention on the appropriateness of referrals and the proportion of referred patients from general practitioners (GPs) who underwent lumbar MRI. Methods: A quasi-experimental design with pre- and post-intervention periods was employed. We included GP referrals for lumbar spine MRI at Silkeborg Regional Hospital, Denmark, among adults ≥ 18 years from 1 January 2019 to 31 August 2023. The intervention, which consisted of template-based correspondence letters and a guidance booklet, was implemented on 1 September 2022. Referrals were classified as either ‘appropriate’ or ‘inappropriate’ according to international guidelines. Interrupted time-series analysis with segmented regression was applied to evaluate change over time in referral appropriateness and the proportion of lumbar MRIs within 90 days of referral. Results: A total of 5222 referrals were received (80.6% pre and 19.4% post intervention). Patient characteristics were comparable across the periods. The proportion of appropriate referrals increased from 49.7 to 60.0%. At the onset of the intervention, the level of appropriate referrals increased by 6.50% points (95% CI 0.71, 12.29), and the trend changed by 0.98 (95% CI 0.36, 1.59), reaching 0.90 (95% CI 0.30, 1.49). This implied a continued increase in the pre-post difference. The proportion of referred patients having lumbar MRIs decreased from 92.2 to 75.7%. At intervention onset, the level of lumbar MRIs changed by − 17.06 (95% CI − 23.25, − 10.88). However, post-intervention the trend changed, becoming positive (0.66, 95% CI − 0.05, 1.37), implying that the number of lumbar MRIs could return to pre-intervention level over time. Conclusion: The intervention increased the proportion of appropriate referrals for lumbar MRI. For the proportion of MRIs performed, we found an immediate reduction, but this may not be sustained over time.

Globally, low back pain (LBP) is the leading cause of years lived with disability. Clear communication between patients and health professionals is essenti

Background: Degenerative disk disease (DDD) is a progressive condition that occurs when the intervertebral discs (IVDs), which act as shock absorbers between the vertebrae, degenerate or wear out. Due to this degeneration process, the mechanical properties of the IVD, providing flexibility between adjacent vertebrae, can change. Thus, assessing these mechanical properties may improve diagnosis and treatment guidance for DDD. In this article, we tested in vivo multifrequency magnetic resonance elastography (MMRE) of the human IVD in identifying progressively DDD in three asymptomatic male volunteers aged 32, 50, and 60 years. Methods: MMRE of the lumbar spine was acquired using a dual‐actuator setup and operated at four frequencies from 60 to 90 Hz. MMRE data were postprocessed using multifrequency wave‐number recovery (k‐MDEV) inversion algorithm. The resulting shear wave speed (SWS) values were used as a surrogate parameter of tissue stiffness and then compared to Pfirrmann grading (Pf) of disc degeneration (1–5) performed by an experienced MRI spine researcher. Results: Morphological Pf demonstrated an inverse relationship between increasing IVD stiffness and progressive IVD degeneration by a Spearman’s rank correlation coefficient of ρ = −0.792, p < 0.001. Conclusion: MMRE allows measurement of in vivo mechanical properties of IVDs and may provide additional information in disc degeneration beyond standard morphological changes. Prior to the clinical use of this technique, future studies should be conducted to evaluate the reproducibility and repeatability of spinal MMRE in the spine, and particularly its potential confounders.

Background: Access to clear and comprehensible health information is crucial for patient empowerment, leading to improved self-care, adherence to treatment plans, and overall health outcomes. Traditional methods of information delivery, such as written documents and oral communication, often result in poor memorization and comprehension. Recent innovations, such as animation videos, have shown promise in enhancing patient understanding, but comprehensive investigations into their effectiveness across various health care settings are lacking. Objective: This systematic review aims to investigate the effectiveness of animation videos on health information recall in adult patients across diverse health care sectors, comparing their impact to usual information delivery methods on short-term and long-term recall of health information. Methods: We conducted systematic searches in PubMed, CINAHL, and Embase databases, supplemented by manual searches of reference lists. Included studies were randomized controlled trials involving adult participants (≥18 years) that focused on the use of animation videos to provide health information measured against usual information delivery practice. There were no language restrictions. Out of 2 independent reviewers screened studies, extracted data, and assessed the risk of bias using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2), Covidence was used to handle screening and risk of bias process. A narrative synthesis approach was applied to present results. Results: A total of 15 randomized controlled trials—3 in the United States, 2 in France, 2 in Australia, 2 in Canada, and 1 in the United Kingdom, Japan, Singapore, Brazil, Austria, and Türkiye, respectively—met the inclusion criteria, encompassing 2,454 patients across various health care settings. The majority of studies (11/15, 73%) reported statistically significant improvements in health information recall when animation videos were used, compared with usual care. Animation videos ranged from 1 to 15 minutes in duration with the most common length ranging from 1 to 8 minutes (10/15) and used various styles including 2D cartoons, 3D computers, and whiteboard animations. Most studies (12/15) assessed information recall immediately after intervention, with only 3 studies including longer follow-up periods. Most studies exhibited some concerns related to the risk of bias, particularly in domains related to deviations from intended interventions and selection of reported results. Conclusions: Animation videos appear to significantly improve short-term recall of health information among adult patients across various health care settings compared with usual care. This suggests that animation videos could be a valuable tool for informing patients in different health care settings. However, further research is needed to explore the long-term efficacy of these interventions, their impact on diverse populations, and how different animation styles might affect information recall. Future studies should also address methodological limitations identified in current research, including the use of validated outcome measures and longer follow-up periods. Trial Registration: PROSPERO CRD42022380016; http://crd.york.ac.uk/prospero/display_record.php?RecordID=380016

BACKGROUND Access to clear and comprehensible health information is crucial for patient empowerment, leading to improved self-care, adherence to treatment plans, and overall health outcomes. Traditional methods of information delivery, such as written documents and oral communication, often result in poor memorization and comprehension. Recent innovations, such as animation videos, have shown promise in enhancing patient understanding, but comprehensive investigations into their effectiveness across various health care settings are lacking. OBJECTIVE This systematic review aims to investigate the effectiveness of animation videos on health information recall in adult patients across diverse health care sectors, comparing their impact to usual information delivery methods on short-term and long-term recall of health information. METHODS We conducted systematic searches in PubMed, CINAHL, and Embase databases, supplemented by manual searches of reference lists. Included studies were randomized controlled trials involving adult participants (≥18 years) that focused on the use of animation videos to provide health information measured against usual information delivery practice. There were no language restrictions. Out of 2 independent reviewers screened studies, extracted data, and assessed the risk of bias using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2), Covidence was used to handle screening and risk of bias process. A narrative synthesis approach was applied to present results. RESULTS A total of 15 randomized controlled trials—3 in the United States, 2 in France, 2 in Australia, 2 in Canada, and 1 in the United Kingdom, Japan, Singapore, Brazil, Austria, and Türkiye, respectively—met the inclusion criteria, encompassing 2,454 patients across various health care settings. The majority of studies (11/15, 73%) reported statistically significant improvements in health information recall when animation videos were used, compared with usual care. Animation videos ranged from 1 to 15 minutes in duration with the most common length ranging from 1 to 8 minutes (10/15) and used various styles including 2D cartoons, 3D computers, and whiteboard animations. Most studies (12/15) assessed information recall immediately after intervention, with only 3 studies including longer follow-up periods. Most studies exhibited some concerns related to the risk of bias, particularly in domains related to deviations from intended interventions and selection of reported results. CONCLUSIONS Animation videos appear to significantly improve short-term recall of health information among adult patients across various health care settings compared with usual care. This suggests that animation videos could be a valuable tool for informing patients in different health care settings. However, further research is needed to explore the long-term efficacy of these interventions, their impact on diverse populations, and how different animation styles might affect information recall. Future studies should also address methodological limitations identified in current research, including the use of validated outcome measures and longer follow-up periods. CLINICALTRIAL PROSPERO CRD42022380016; http://crd.york.ac.uk/prospero/display_record.php?RecordID=380016

Background: In Denmark, chiropractors have a statutory right to use radiography and the government-funded national Health Insurance provides partial reimbursement. Danish National Clinical Guidelines recommends against routine use of imaging for uncomplicated spinal pain; however, it is not clear if clinical imaging guidelines recommendations have had an effect on the utilisation of spinal radiography. This study aimed to describe the utilisation rate of radiographs in Danish chiropractic clinics in the period from 2010 to 2020 and to assess the impact of clinical guidelines and policy changes on the utilisation of radiographs in Danish chiropractic clinics. Methods: Anonymised data from January 1st, 2010, to December 31st, 2020, were extracted from the Danish Regions register on health contacts in primary care. Data consisted of the total number of patients consulting one of 254 chiropractic clinics and the total number of patients having or being referred for radiography. Data were used to investigate the radiography utilisation per month from 2010 to 2020. An ‘interrupted time series’ analysis was conducted to determine if two interventions, the dissemination of 1) Danish clinical imaging guidelines recommendations and policy changes related to referral for advanced imaging for chiropractors in 2013 and 2) four Danish clinical guidelines recommendations in 2016, were associated with an immediate change in the level and/or slope of radiography utilisation. Results: In total, 336,128 unique patients consulted a chiropractor in 2010 of which 55,449 (15.4%) had radiography. In 2020, the number of patients consulting a chiropractor had increased to 366,732 of which 29,244 (8.0%) had radiography. The pre-intervention utilisation decreased by two radiographs per 10,000 patients per month. Little absolute change, but still statistically significant for Intervention 1, in the utilisation was found after the dissemination of the clinical guidelines and policy changes in 2013 or 2016. Conclusions: The proportion of Danish chiropractic patients undergoing radiography was halved in the period from 2010 to 2020. However, the dissemination of clinical imaging guidelines recommendations and policy changes related to referrals for advanced imaging showed little meaningful change in the monthly utilisation of radiographs in the same period.

Low back pain (LBP) is the leading cause of disability worldwide. Providing evidence-based practice (EBP) for patients with LBP is more cost-effective compared with non-EBP. To help health care pro... It is important that physiotherapists and chiropractors reflect on what constitutes their core task and professional identity if the implementation of the biopsychosocial model is to be successful....