Consultation imaging for musculoskeletal pain in primary care: Development of a complex intervention to prevent underuse, misuse, and overuse.

• Applicant: Professorin Dr. Annika Viniol
• Subject Area: Public Health, Healthcare Research, Social and Occupational Medicine
• Term: since 2023
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 528318396

Imaging technology has significantly advanced diagnostic testing in medicine and resulting therapies and treatment decisions. As with all diagnostic tests, the use of the diagnostic test "imaging" is not appropriate in all situations. In patients with musculoskeletal pain, the timing for appropriate imaging is often not ideally found. Resulting disadvantages for patients are described detailed in the literature, including: 1) imaging can lead to a false negative impression of patients about the condition/prognosis of their musculoskeletal apparatus, which in turn can lead to fear avoidance behaviors that worsen rather than improve the pain experience; 2) there is a risk for incorrect image interpretation and resulting unnecessary treatment. Primary care physicians have a key role in deciding whether and when to perform imaging for musculoskeletal pain. However, the decision-making process is complex and characterized by sometimes differing expectations on the part of patients and physicians. Supportive guidance on the use of imaging is so far only scattered in the different pain syndrome-specific guidelines and the "Orientation Guide for Imaging Procedures" of the Radiation Protection Commission does not offer clinically differentiated recommendations that can be transferred to the GP consultation situation. The aim of this project is to develop a complex intervention to support primary care physicians and patients in making decisions about the use of imaging in musculoskeletal pain. In accordance with international recommendations for the development of complex interventions, the intervention will be developed using a program theory. This will incorporate findings from the literature and an expert questioning. In addition, a panel of experts, including future users, will accompany the intervention development. The planned intervention is intended to increase the decision-making competence of physicians and patients in situations where imaging is required for musculoskeletal pain. For this purpose, three modules will be developed: 1) Multimedia training module on "Imaging in musculoskeletal pain" (for general practitioners); 2) General practitioner decision support on "Use of imaging in musculoskeletal pain", 3) Patient information on "Imaging in musculoskeletal pain". The proposal presented here includes the development of the complex intervention as well as a subsequent revision phase of the intervention after practice test. As part of a subsequent follow-up project, it is planned to investigate the feasibility/effectiveness of the intervention.

• DFG Programme: Research Grants
• Co-Investigator: Veronika Van der Wardt, Ph.D.