Content analysis of general practitioner-requested lumbar spine X-ray reports

Abstract

X-rays of patients with lower back pain rarely show serious pathology but frequently reveal incidental age-related changes and always expose people to radiation. Patients who have X-rays are more satisfied but report worse pain and disability. Psychological factors such as illness beliefs, catastrophizing and fear avoidance have been shown to be predictors of chronicity/disability. Authorities suggest that the way X-ray information is transmitted and interpreted by patients may influence outcome; therefore, this study was designed to determine the words used by radiologists to describe lumbar spine X-rays. 120 consecutive X-ray reports for patients referred by primary care physicians were anonymized, and a formal summative content analysis undertaken. The coded words were grouped into categories according to their perceived meaning, and the process was refined until there were only three mutually exclusive categories. Half of the sample was aged 60 years or less. Three categories were identified: anatomical, pathological and descriptive. In the pathological category, 33% of words described normal appearances, 47% described age-related changes and 20% described other features. In only 2% of cases were pathological words used to describe conditions as being "normal for age". Overall, 89 (74%) of the 120 reports contained at least one phrase containing words indicating the presence of degenerative changes.