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The Value of Diagnostic Tests for Low Back Pain—Reply
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In Reply: We agree with Dr Caplan that there is value in a diagnostic test beyond that measured by functional outcomes alone. That is why we measured not only back-related disability and general health-related quality of life but also the confidence that physicians had in their diagnoses, differences in therapy, and the degree of reassurance that patients received from the diagnostic test. We found an advantage of MRI over radiographs in several of these areas. But these benefits come at a real cost to patients, the medical system, and society as a whole. Ultimately, the goal of a diagnostic test is to improve a patient's health and well-being, albeit via changes in diagnosis and therapy.
Many experts have argued that diagnostic tests must be evaluated not only for their diagnostic accuracy but also for their effects on treatment and outcome.1-2 For patients with back pain, anatomic findings and symptoms are . . . [Full Text of this Article]
Jeffrey G. Jarvik, MD, MPH;
Richard A. Deyo, MD, MPH;
William Hollingworth, PhD
Center for Cost and Outcomes Research
University of Washington
Seattle
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