Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: People aged 16 or over with non-specific low back pain and/or sciatica
Intervention: MRI or X-ray imaging
Comparison: No imaging
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Health-related quality of life (Short Form [SF-36]) bodily pain ≤ 4 months | No statistically significant difference | Low |
Health-related quality of life (SF-36) general health perception ≤ 4 months | No statistically significant difference | Low |
Health-related quality of life (SF-36) vitality ≤ 4 months | Favours intervention | Very Low |
Health-related quality of life (SF-36) role-physical functioning ≤ 4 months | No statistically significant difference | Low |
Health-related quality of life (SF-36) social functioning ≤ 4 months | No statistically significant difference | Very Low |
Health-related quality of life (SF-36) mental health ≤ 4 months | Favours intervention | Very Low |
Health-related quality of life (SF-36) physical functioning ≤ 4 months | No statistically significant difference | Low |
Health-related quality of life (SF-36) role-emotional functioning ≤ 4 months | No statistically significant difference | Very Low |
Health-related quality of life (EQ-5D) Visual Analogue Scale (VAS) ≤ 4 months | No statistically significant difference | Very Low |
Pain severity (Aberdeen Low Back Pain [ALBP] score) > 4 months | Favours intervention | Very Low |
Function (Roland Morris Disability Questionnaire [RMDQ]) ≤ 4 months | No statistically significant difference | Very Low |
Function (RMDQ) > 4 months | No statistically significant difference | Low |
Psychological distress (Hospital Anxiety and Depression Scale [HADS] Anxiety Score) ≤ 4 months | No statistically significant difference | Very Low |
Psychological distress (HADS Anxiety Score) > 4 months | No statistically significant differenc | Low |
Psychological distress (HADS Depression Score) ≤ 4 months | No statistically significant difference | Low |
Psychological distress (HADS Depression Score) > 4 months | No statistically significant difference | Low |
Health-related quality of life (SF-36) bodily pain > 4 months | Favours intervention | Very Low |
Health-related quality of life (SF-36) mental health > 4 months | Favours intervention | Very Low |
Health-related quality of life (SF-36) physical functioning > 4 months | No statistically significant difference | Very Low |
Health-related quality of life (SF-36) social functioning > 4 months | Favours intervention | Very Low |
Health-related quality of life (SF-36) role reported health transition > 4 months | No statistically significant difference | Very Low |
Health-related quality of life (SF-36) vitality > 4 months | Favours intervention | Very Low |
Health-related quality of life (SF-36) general health perception > 4 month | No statistically significant difference | Very Low |
Health-related quality of life (SF-36) role-physical functioning > 4 months | No statistically significant difference | Very Low |
Health-related quality of life (SF-36) role-emotional functioning >4 months | No statistically significant difference | Very Low |
Health-related quality of life (EQ-5D, 0-1) > 4 months | Favours intervention | Very Low |
Health-related quality of life (EQ-5D) VAS > 4 months | No statistically significant difference | Very Low |
Recommendations as stated in the source guideline The guideline development group states that imaging should not be routinely offered in a non-specialist setting for people with low back pain with or without sciatica. Explain to people with low back pain with or without sciatica that if they are being referred for specialist opinion, they may not need imaging. Consider imaging in specialist settings of care (e.g., a musculoskeletal interface clinic or hospital) for people with low back pain with or without sciatica only if the result is likely to change management.
Note The guideline development group has described the outcomes in this table as critical. Healthcare utilisation, responder criteria and adverse events are also included in the guideline as important outcomes; no evidence was found for the latter two. Please see the full-text guideline document for more information on these outcomes. The results in this table are based on randomised controlled trial (RCT) evidence, four of which compared X-ray with no imaging while the fifth compared MRI with no imaging. Most of the evidence in favour of imaging came from a single RCT in a secondary care setting. However, the guideline development group also notes that very low-quality cohort study evidence comparing X-ray with no imaging showed no clinical difference or clinical benefit in favour of no imaging for quality of life at both short and longer term follow-ups. It also acknowledged that, for most comparisons, the evidence was limited and from a small number of studies.
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