Australasian Faculty of Rehabilitation Medicine
Recommendations from the Australasian Faculty of Rehabilitation Medicine. The Australasian Faculty of Rehabilitation Medicine (AFRM) is a Faculty of the Royal Australasian College of Physicians (RACP). AFRM provides training and continuing education for Rehabilitation Medicine Fellows and trainees throughout all stages of their career. AFRM trainees and Fellows are committed to providing high quality rehabilitation care to individuals and communities in Australia and New Zealand.
Do not use imaging for diagnosing non-specific acute low back pain in the absence of red flags.
The majority of acute low back pain episodes are benign, self-limited cases that do not warrant the use of imaging (e.g. X-rays, CT or MRI). There is evidence that early imaging for low back pain in the absence of red flags does not facilitate improvements in primary outcomes such as pain and function, even for older patients. If anything such imaging may be harmful insofar as it may reveal incidental findings that divert attention and increase the risk of having unnecessary interventions and invasive treatments including unnecessary surgery.
- Chou R, Fu R, Carrino JA, et al. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet 2009; 373:463-72.
- Graves JM, Fulton-Kehoe D, Martin DP, et al. Factors associated with early magnetic resonance imaging utilization for acute occupational low back pain: a population-based study from Washington State Workers' Compensation. Spine 2012; 37(19):1708-18.
- Jarvik JG, Gold LS, Comstock BA, et al. Association of early imaging for back pain with clinical outcomes in older adults. Jama 2015; 313(11):1143-53.
- Webster BS, Bauer AZ, Choi Y, et al. Iatrogenic consequences of early magnetic resonance imaging in acute, work-related, disabling low back pain. Spine 2013; 38(22):1939-46.
A working group within AFRM initially identified 10 recommendations on low value practices in the field of rehabilitation medicine that may be widespread in Australia and New Zealand. Following a review of the evidence these were reduced to seven. An online survey based on these seven recommendations was distributed to all AFRM members asking them to rate these recommendations based on whether they thought they were evidence based, whether the low-value practices targeted were still being undertaken in significant numbers, and whether the recommendation was important in terms of reducing harm and unnecessary costs to patients. The working group reviewed the feedback and finalised the ‘top 5’ recommendations which were approved by AFRM Executive in mid-2017.
- 1 Do not discharge patients with osteoporotic fractures without an assessment and/or treatment for osteoporosis.
- 2 Do not prescribe spinal orthotics or bed rest for patients with non-specific low back pain.
- 3 Do not use Mini Mental State Examination as the only tool to assess cognitive deficit in acquired brain injury.
- 4 Do not routinely use splinting for prevention and/or management of contractures after stroke.
- 5 Do not use imaging for diagnosing non-specific acute low back pain in the absence of red flags.