To Choose or Not To Choose: Evaluating the Effect of a Choosing Wisely Knowledge Translation Initiative for Imaging in Low Back Pain by Emergency Physicians

Introduction: We aimed to quantify the baseline familiarity of emergency medicine (EM) physicians with the Choosing Wisely Canada (CWC)-EM recommendations. We then assessed whether a structured knowledge translation (KT) initiative affected awareness, knowledge, and practice patterns for imaging in low back pain. Methods: We completed a two-center, before and after practice evaluation study. Physicians working in two Canadian emergency departments (EDs) were asked to participate in a survey before a KT initiative, and were surveyed again at a six-month follow up period post-intervention. The primary outcome of physician practice was determined by analyzing the frequency of lumbar X-ray imaging for back pain. Results: A total of 37 physicians were asked to complete the pre- and post-intervention survey. Awareness of the CWC-EM recommendations increased following the intervention (63%; 95%CI: 43-79 at baseline vs. 86%; 66-96 post-intervention). Knowledge increased with 58% (39-76) of physicians responding correctly initially, and 86% (66-96) after the intervention. Despite increases in awareness and knowledge of the guidelines, the lumbar X-ray imaging rate increased from a baseline of 12% (9.9-14.5) to 16.2% (13.6-19.2; p = 0.023) following the intervention. Conclusion: We demonstrated some improvements in physician awareness and knowledge of the CWC-EM recommendations following our intervention. Despite these improvements, our KT intervention was associated with an increased frequency of imaging for low back pain, contrary to our expectations.