The Top Five overused clinical activities published in the October 2011 Archives of Internal Medicine includes at least one activity that affects many physical therapists' patients: imaging for lower back pain.
| Overused Clinical Activity | Rank | Cost to American Patients (in millions of dollars) |
|---|---|---|
| Expensive Brand Name Statins for Hypercholesterolemia | 1 | $5,800 |
| Dual X-ray (DEXA) bone scans for Osteoporosis | 2 | $527 |
| ANY imaging for Lower Back Pain | 3 | $175 |
| Antibiotics for Children with Viral Colds | 4 | $116 |
| Pap Tests for Patients Under 21 years of age | 5 | $47 |
The "Top Five" collectively surpass $6 billion dollars in wasted healthcare dollars and, according to the study authors, the Good Stewardship Working Group of primary care physicians...
"All activities were believed to be common in primary care but of little benefit to patients."This Archives article coincides nicely with the November Journal of Orthopedic and Sports Physical Therapists (JOSPT) in which Flynn, Smith and Chou discuss the Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good.
Not only is imaging lower back pain expensive, but the patient ends up more likely to have back surgery after physicians view the image.
Further, the visualization by the patient of something "wrong" in their spine leads to avoidance of normal, healthy activity.
If the coincident publication of these two articles wasn't planned then I guess it's just good timing.
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