Implementing Evidence-Based Guidelines for Radiography in Acute Low Back Pain: A Pilot Study in a Chiropractic Community (original) (raw)
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Journal of Manipulative and Physiological Therapeutics, 2002
Background: Recent studies suggest that chiropractors continue to widely use radiography for assessing patients with acute low back pain. This practice is contrary to growing evidence that suggests only a small percentage of patients with acute low back pain require radiographic evaluation. Objectives: To assess quantitatively and qualitatively the views of chiropractors in a selected community in Ontario on the use of radiography for evaluating patients with acute low back pain. Study Design: Mailed surveys and focus group interview. Method: Surveys were mailed to all chiropractors (N ϭ 26) in a selected community in Ontario, followed by a focus group session with local chiropractors (n ϭ 7). Surveys requested information on personal and practice characteristics and the management of low back pain, including the use of radiography. The focus group, led by a facilitator, discussed issues surrounding practice guidelines and radiography use. Results: There was a 76% response rate to the mailed surveys. Of those who responded, 63% stated they would use radiography on patients with uncomplicated acute low back pain lasting 1 week; 68% stated that radiographs were useful in the diagnostic evaluation of patients with acute low back pain lasting less than 1 month. Most reasons given for use of radiography in this patient population are not supported by existing evidence.
Adherence to Radiography Guidelines for Low Back Pain: A Survey of Chiropractic Schools Worldwide
Journal of Manipulative and Physiological Therapeutics, 2008
Objective: This study describes instruction provided at chiropractic schools worldwide on the use of spine radiography and compares instruction with evidence-based guidelines for low back pain. Methods: Individuals responsible for radiology instruction at accredited chiropractic schools throughout the world were contacted and invited to participate in a Web-based survey. The survey included questions on the role of conventional radiography in chiropractic practice and instruction given to students for its use in patients with acute low back pain. Results: Of the 33 chiropractic schools identified worldwide, 32 (97%) participated in the survey. Consistent with the guidelines, 25 (78%) respondents disagreed that "routine radiography should be used prior to spinal manipulative therapy," 29 (91%) disagreed that there "was a role for full spine radiography for assessing patients with low back pain," and 29 (91%) disagreed that "oblique views should be part of a standard radiographic series for low back pain." However, only 14 (44%) respondents concurred with the guidelines and disagreed with the statement that there "is a role for radiography in acute low back pain in the absence of 'red flags' for serious disease." Conclusions: This survey suggests that many aspects of radiology instruction provided by accredited chiropractic schools appear to be evidence based. However, there appears to be a disparity between some schools and existing evidence with respect to the role of radiography for patients with acute low back pain without "red flags" for serious disease. This may contribute to chiropractic overutilization of radiography for low back pain. (J Manipulative Physiol Ther 2008;31:412-418) Key Indexing Terms: Public health; Chiropractic M ore than 90 000 chiropractors practice internationally, and this number is expected to grow to 150 000 by the year 2010. 1 Most practicing chiropractors are graduates of one of approximately 30
Chiropractic & Manual Therapies, 2021
Background Low back pain (LBP) rarely requires routine imaging of the lumbar spine in the primary care setting, as serious spinal pathology is rare. Despite evidence-based clinical practice guidelines recommending delaying imaging in the absence of red flags, chiropractors commonly order imaging outside of these guidelines. The purpose of this study was to survey chiropractors to determine the level of knowledge, adherence to, and beliefs about, clinical practice guidelines related to the use of lumbar radiography for LBP in Newfoundland and Labrador (NL), Canada. Methods A cross-sectional survey of chiropractors in NL (n = 69) was conducted between May and June 2018, including questions on demographics, awareness of radiographic guidelines, and beliefs about radiographs for LBP. We assessed behavioural simulation using clinical vignettes to determine levels of adherence to LBP guideline recommendations. Results The response rate was 77% (n = 53). Half of the participants stated the...
Prevalance of Radiological Investigation in Low Back Pain – an Observational Study
PARIPEX INDIAN JOURNAL OF RESEARCH
Introduction: Lumbar spine pathology is major healthcare burden encountered in district and urban hospitals. Diagnostic imaging in these patients is not always indicated.Imaging is considered in those patients who show little or no improvement in their LBP after approximately six weeks of medical management with or without physical therapy,the current study was undertaken to assess the appropriateness of LBP imaging in primary care following the ACP guidelines. Method: The inclusion criteria for the study were adult patients with persistent low back pain with or without radiculopathy post six weeks of medical management affecting their activity of daily living. And the exclusion criteria were spinal trauma ,neurological impairment,bladder and bowel involvement, spinal malformations,history of malignancy presenting at the time of index visit. Result: The study included total 115 patients. Out of 115 patients 87 [70%] patients showed abnormal finding on the radiographs.The most common...
Clinical Practice Guideline: Chiropractic Care for Low Back Pain
Journal of manipulative and physiological therapeutics, 2016
The purpose of this article is to provide an update of a previously published evidence-based practice guideline on chiropractic management of low back pain. This project updated and combined 3 previous guidelines. A systematic review of articles published between October 2009 through February 2014 was conducted to update the literature published since the previous Council on Chiropractic Guidelines and Practice Parameters (CCGPP) guideline was developed. Articles with new relevant information were summarized and provided to the Delphi panel as background information along with the previous CCGPP guidelines. Delphi panelists who served on previous consensus projects and represented a broad sampling of jurisdictions and practice experience related to low back pain management were invited to participate. Thirty-seven panelists participated; 33 were doctors of chiropractic (DCs). In addition, public comment was sought by posting the consensus statements on the CCGPP Web site. The RAND-U...