Consumer understanding of terms used in imaging reports requested for low back pain: a cross-sectional survey

Caitlin Farmer, Denise A O'Connor, Hopin Lee, Kirsten McCaffery, Christopher Maher, Dave Newell, Aidan Cashin, David Byfield, Jeffrey Jarvik, Rachelle Buchbinder

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ObjectivesTo investigate (1) self-reported societal comprehension of common and usually non-serious terms found in lumbar spine imaging reports and (2) its relationship to perceived seriousness, likely persistence of low back pain (LBP), fear of movement, back beliefs and history and intensity of LBP.DesignCross-sectional online survey of the general public.SettingFive English-speaking countries: UK, USA, Canada, New Zealand and Australia.ParticipantsAdults (age >18 years) with or without a history of LBP recruited in April 2019 with quotas for country, age and gender.Primary and secondary outcome measuresSelf-reported understanding of 14 terms (annular fissure, disc bulge, disc degeneration, disc extrusion, disc height loss, disc protrusion, disc signal loss, facet joint degeneration, high intensity zone, mild canal stenosis, Modic changes, nerve root contact, spondylolisthesis and spondylosis) commonly found in lumbar spine imaging reports. For each term, we also elicited worry about its seriousness, and whether its presence would indicate pain persistence and prompt fear of movement.ResultsFrom 774 responses, we included 677 (87.5%) with complete and valid responses. 577 (85%) participants had a current or past history of LBP of whom 251 (44%) had received lumbar spine imaging. Self-reported understanding of all terms was poor. At best, 235 (35%) reported understanding the term 'disc degeneration', while only 71 (10.5%) reported understanding the term 'Modic changes'. For all terms, a moderate to large proportion of participants (range 59%-71%), considered they indicated a serious back problem, that pain might persist (range 52%-71%) and they would be fearful of movement (range 42%-57%).ConclusionCommon and usually non-serious terms in lumbar spine imaging reports are poorly understood by the general population and may contribute to the burden of LBP.Trial registration numberACTRN12619000545167.
Original languageEnglish
Article numbere049938
Number of pages10
JournalBMJ Open
Issue number9
Publication statusPublished - 1 Sept 2021


  • Back Pain
  • Musculoskeletal Disorders
  • Diagnostic Radiology


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