Rozbroj, Tomas

Reed, Benjamin

O'Connor, Denise

Gelber, Nicholas

Bourne, Allison

Maher, Chris

Buchbinder, Rachelle

2025-06-01

General practitioners (GPs) use of imaging for acute low back pain (LBP) is above guideline recommendations, and the reasons for this remain under-researched. We examined the perspectives, expectations and information needs of Australian GPs requesting lumbar spine diagnostic imaging for patients presenting with acute LBP.We completed semi-structured interviews with 12 GPs practising in Victoria, Australia. Transcripts were thematically analysed, and themes compared according to whether or not GPs reported they regularly requested imaging for LBP.We identified four themes. (1) Besides responding to 'red flags', GPs' experiences of uncovering unexpected but serious findings on imaging for LBP as well as perceived external pressures motivated their defensive imaging practices. (2) While most were reluctant to request imaging for LBP, once requested, GPs escalated through imaging modalities and focused on the diagnostic benefit of their findings. (3) GPs supported the inclusion of epidemiological data on imaging reports, but (4) largely opposed imaging reports being written in plain language, believing reports to be clinician-to-clinician communications that patients would misunderstand. All GPs were aware of the limited utility of imaging for diagnosing LBP, and themes were similar between GPs who regularly requested imaging and those who did not. Factors other than knowledge of imaging efficacy for LBP seemed to play an important role in imaging requests.Our study identified key drivers of imaging use for LBP in primary care. The findings underscore that interventions targeting GPs addressing the overuse of imaging for LBP should transcend knowledge deficit models.

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

Royal Darwin Hospital, Tiwi, Australia.

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

Cabrini Research, Malvern, Australia.

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

School of Public Health, University of Sydney, Sydney, Australia.

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

Musculoskeletal Care . 2025 Jun;23(2):e70099. doi: 10.1002/msc.70099.

1557-0681

0000-0002-3084-746X

0000-0003-3678-089X

0000-0002-6836-122X

0000-0002-6454-8214

0000-0002-1628-7857

0000-0002-0597-0933

https://pubmed.ncbi.nlm.nih.gov/40215089/?otool=iaurydwlib

https://hdl.handle.net/10137/14241

Australia

diagnostic imaging

general practice

low back pain

overdiagnosis

radiolog* report*

Low Back Pain

Humans

General Practitioners

Male

Qualitative Research

Female

Practice Patterns, Physicians'

Lumbar Vertebrae

Middle Aged

Adult

Victoria

Attitude of Health Personnel

Australian General Practitioners' Use of Diagnostic Lumbar Spine Imaging for Patients With Acute Low Back Pain: A Qualitative Study.

Journal Article

Publication