Background/Purpose: Management of nonspecific acute low back pain (LBP) is complicated by many patients’ belief that imaging tests will be useful. Choosing Wisely is a campaign that represents a physician-driven effort to create conversations between physicians and patients around overuse and waste. The objective of this study was to determine the potential impact of the Choosing Wisely educational pamphlet on patients’ behavioural intentions for future imaging tests.

Methods: We recruited a cohort representative of the Canadian adult general population to a web survey in English and French to consider the impact of the Choosing Wisely campaign for LBP. We first ascertained respondents’ experiences of LBP, and baseline behavioural intentions for a future LBP episode, including attitudes, beliefs and knowledge on LBP and imaging tests. We next asked respondents to read the Choosing Wisely pamphlet before asking follow-up questions to understand the pamphlet’s potential impact.

Results: Of the 3386 respondents that began the survey, 2985 completed all questions and were included in the analysis. Respondents broadly matched the age and gender of the Canadian population, with 7% completing the survey in French. 1918 (64%) of respondents reported an episode of LBP in the past year, of which 1081 (56%) visited a health professional. Of the 799 who reported they had no red flag, 336 (42%) received an imaging test for their LBP, predominantly X-ray. Overall, 37% and 39% of respondents stated that they would want or expect an imaging test for future LBP. After reading the Choosing Wisely educational pamphlet, this reduced from 39% to 24% (p<0.001) for wanting, and 37% to 22% (p<0.001) for expecting an imaging test. Similar improvement was seen in knowledge questions about the need and potential risks of imaging tests, and for alternative management strategies.

Conclusion: The Choosing Wisely pamphlet for LBP was effective in changing some individuals’ behavioural intentions around imaging tests. Simple extrapolation implies in Canada each year there are over 2 million inappropriate x-rays and 700,000 inappropriate MRIs for LBP. This costs between $300-$600 million per year. Conservative estimates suggest implementing the Choosing Wisely campaign could save $30 million per year. Future analysis will explore subgroups where the influence of the Choosing Wisely pamphlet is most and least. Follow-up studies are planned to assess whether respondents stated changes in behavioural intentions.