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RESEARCH ARTICLE (Open Access)
Contents Vol 17(3)

Imaging in low back pain: a cross-sectional analysis of Australian early-career general practitioners’ ordering of imaging for non-specific low back pain

Tobias Morgan 1 , Alexandra Sheather 2 , Anna Ralston 2 3 , Elizabeth Holliday 2 , Jean Ball 4 , Mieke van Driel 5 , Andrew Davey 2 3 , Adele Kincses 3 , Amanda Tapley 2 3 , Alison Fielding 2 3 , Dominica Moad 2 3 , Parker Magin https://orcid.org/0000-0001-8071-8749 2 3 *
+ Author Affiliations
- Author Affiliations

1 School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Samuels Building, F25, Samuel Terry Avenue, Kensington, NSW 2033, Australia.

2 School of Medicine & Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia.

3 Royal Australian College of General Practitioners GP Training Research Unit, Level 1, 20 Mcintosh Drive, Mayfield West, NSW 2304, Australia.

4 Clinical Research Design IT and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.

5 General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, 288 Herston Road, Brisbane, Qld 4006, Australia.

* Correspondence to: parker.magin@newcastle.edu.au

Handling Editor: Felicity Goodyear-Smith

Journal of Primary Health Care 17(3) 224-232 https://doi.org/10.1071/HC25056
Submitted: 31 March 2025  Accepted: 23 June 2025  Published: 31 July 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction

Low back pain is a leading cause of morbidity worldwide, but its cause is often non-specific. Imaging should not take place unless there are specific ‘red flag’ features present, as it does not improve patient outcomes.

Aim

To establish prevalence and factors associated with ordering of imaging for new onset non-specific low back pain (new onset NSLBP) by early-career GPs (‘registrars’).

Methods

Cross-sectional analysis from a subset of data from the ReCEnT study of GP registrars’ clinical experiences (2010–2018). The outcome was whether imaging was ordered for a patient with new onset NSLBP. Analyses employed univariable and multivariable regression.

Results

A total of 2333 GP registrars (96.0% response rate) contributed data from 325,058 consultations, comprising 508,316 patient problems/diagnoses. A total of 3066 problems/diagnoses (0.6%) were new onset NSLBP. Of the 3066 new onset NSLBP problems/diagnoses, 450 (15%) had imaging ordered. In multivariable models, variables significantly associated with imaging for new onset NSLBP were patient age: 35-64 years (adjusted OR 1.55, P = 0.002) or over 65 years (OR 2.32, P < 0.001) compared to patients aged 15–34 years, ‘seeking in-consultation help from a supervisor’ (OR 1.74, P = 0.009), scheduling of follow-up with the registrar (OR 3.61, P < 0.001) or another GP (OR 2.01, P = 0.013), and ‘generation of learning goals’ (OR 1.96, P = <0.001). Imaging was negatively associated with referral (OR 0.48, P < 0.001) as was ‘prescription of medication’ (OR 0.63, P < 0.001).

Discussion

Although Australian GP registrars are taking a considered approach to imaging for NSLBP, the prevalence of imaging likely exceeds optimal levels, at significant cost and potentially poorer patient outcomes. Refinement in guidelines regarding appropriate ‘red flags’ for imaging may aid in the further reduction of unnecessary imaging.

Keywords: diagnostic imaging, education, evidence-based practice, family, general practice, graduate, low back pain, medical, physicians.

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