January 26, 2018: The Lumbar Imaging with Reporting of Epidemiology (LIRE) Trial: Subsequent Cross-Sectional Imaging Through 90 Days—Preliminary Results

Speakers

Jeffrey (Jerry) G. Jarvik MD MPH
Professor, Radiology, Neurological Surgery and Health Services
Adjunct Professor, Pharmacy and Orthopedics & Sports Medicine
Co-Director, Comparative Effectiveness, Cost and Outcomes Research Center
Director, UW CLEAR Center for Musculoskeletal Disorders
University of Washington

Patrick J. Heagerty PhD
Gilbert S. Omenn Endowed Chair in Biostatistics
Professor and Chair, Department of Biostatistics
University of Washington

Topic

The Lumbar Imaging with Reporting of Epidemiology (LIRE) Trial: Subsequent Cross-Sectional Imaging Through 90 Days—Preliminary Results

Keywords

Pragmatic clinical trial; LIRE; Lumbar imaging; Spinal imaging; Low back pain; Benchmark data

Key Points

  • The Lumbar Imaging with Reporting of Epidemiology (LIRE) study hypothesis was that adding prevalence benchmark data to spinal imaging would reduce future injections, surgery, and opioid prescriptions.
  • A recent study by Fried et al. in Radiology showed that inclusion of benchmark data in lumbar reports is associated with decreased utilization of high-cost low back pain management.
  • The study has enrolled over 240,000 patients at 4 sites, with the majority of patients older than 40 and receiving imaging through standard x-rays or MRIs.
  • Researchers have analyzed data from two of the four sites so far, and results showed minor reduction in follow-up care for intervention group versus control group. Due to the large, complex data set, they will need more time to review and look at fixed effects.

Discussion Themes

The LIRE study used a stepped-wedge design with five waves, where the randomization was broken down so that all five waves would receive the intervention by the end of the accrual period.

Researchers have consolidated duplicate records within the data set during their analysis by cross-referencing different data pulls over time.

This study could be considered “research to see the details of delivery,” in that researchers learned a lot about patterns of clinician x-ray/MRI ordering behavior, and this helped them to determine definitions of what constitutes an index or an outcome.

 

For information on the LIRE study, visit The Living Textbook: http://bit.ly/2nftls1

Tags

@PCTGrandRounds, @UWMedicine, @kpwashington, @MayoClinic, @KPShare, @HenryFordNews, #lowbackpain, #pctGR

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