Understanding the use of diagnostic imaging and its role in decision-making in musculoskeletal pain conditions affecting the lower back, knee, and shoulder

Cuff, Andrew V (2024) Understanding the use of diagnostic imaging and its role in decision-making in musculoskeletal pain conditions affecting the lower back, knee, and shoulder. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Musculoskeletal (MSK) pain conditions are one of the most common reasons for primary care consultation. The epidemiological evidence suggests that the most common body sites for MSK pain are the lower back, knee, and shoulder respectively, with most presentations being non-traumatic in nature. In turn, this PhD focuses on non-traumatic MSK pain conditions affecting the lower back, knee, and shoulder. The use of diagnostic imaging has been acknowledged as a challenge within the NHS, with year-on-year increases in the number of diagnostics being requested contributing to extra demand on radiology services. In many situations, there is considerable clinical uncertainty in relation to the diagnosis and when this uncertainty exists, it has also been reported that scan results are perceived by patients as authoritative. This PhD thesis used multi-methods design to achieve the aims of better understanding the reasons for requesting imaging, and how the results are used. Two scoping reviews are presented which outline the recommendations for imaging use from clinical practice guidelines, and how these are largely consistent with recommendations within public-facing websites. These recommendations outline how the routine use of diagnostic imaging is discouraged, reserved for cases where specific or serious pathology is suspected or where the person is not responding to initial management and the result is expected to change clinical management. Two qualitative studies are then presented that explore why and how imaging is used from the perspective of the patient and the clinician. These findings consider the role of patient expectations, making sense of symptoms, managing uncertainty, and involvement in decision-making. The findings of this PhD conclude with recommendations for practice, policy and research with a focus on the potential of personalised care and communication skills as methods to optimise diagnostic imaging use. A foundation has been established upon which further research could be undertaken.