Effect of diagnostic labelling on management intentions for non-specific low back pain: a randomised scenario-based experiment

BACKGROUND: Diagnostic labels may influence treatment intentions. We examined the effect of labelling low back pain (LBP) on beliefs about imaging, second opinion, surgery, seriousness, recovery, work, and physical activities.

METHODS: Six-arm online randomised experiment with blinded participants with and without LBP. Participants received one of six labels: "disc bulge", "degeneration", "arthritis", "lumbar sprain", "non-specific LBP", "episode of back pain". The primary outcome was belief about need for imaging.

RESULTS: 1375 participants (mean [SD] age, 41.7 years [18.4 years]; 748 women [54.4%]) were included. Need for imaging was rated lower with the labels "episode of back pain" (4.2 [2.9]), "lumbar sprain" (4.2 [2.9]), and "non-specific LBP" (4.4 [3.0]) compared to the labels "arthritis" (6.0 [2.9]), "degeneration" (5.7 [3.2]), and "disc bulge" (5.7 [3.1]). The same labels led to higher recovery expectations and lower ratings of need for a second opinion, surgery, and perceived seriousness compared to "disc bulge", "degeneration", and "arthritis". Differences were larger among participants with current LBP who had a history of seeking care. No differences were found in beliefs about physical activity and work between the six labels.

CONCLUSIONS: "Episode of back pain", "lumbar sprain" and "non-specific LBP" reduced need for imaging, surgery and second opinion compared to "arthritis", "degeneration" and "disc bulge" among public and patients with LBP as well as reducing the perceived seriousness of LBP and enhancing recovery expectations. The impact of labels appears most relevant among those at risk of poor outcome (participants with current LBP who had a history of seeking care).