Do Chiropractors Adhere to Guidelines for Back Radiographs?
A Study of Chiropractic Teaching Clinics in Canada

This section was compiled by Frank M. Painter, D.C.
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FROM:   Spine 2007 (Oct 15);   32 (22):   2509-2514

Ammendolia C, Côté P, Hogg-Johnson S, Bombardier C

Centre for Research Expertise in Improved Disability Outcomes,
University Health Network, and Institute for Work & Health,
University of Toronto,
Toronto, Ontario, Canada.

STUDY DESIGN:   Clinical cohort.

OBJECTIVES:   To measure the adherence to 3 radiography guidelines for low back pain in chiropractic teaching clinics.

SUMMARY OF BACKGROUND DATA:   Evidence-based guidelines for low back pain suggest that plain radiography should be restricted to patients with suspected serious disease. Among primary healthcare providers who can request radiographs, chiropractors are thought to have utilization rates that exceed what is recommended by practice guidelines. It is uncertain whether this gap between evidence and practice begins in undergraduate training.

METHODS:   We screened 1241 consecutive patients with a new episode of low back pain who presented to any of the 6 out-patient teaching clinics of the Canadian Memorial Chiropractic College between January 2004 and September 2004. We collected information about red flags and radiography recommendations from patients and chiropractic trainees using self-administered questionnaires. Radiography recommendations were compared with criteria used in 3 radiography guidelines. Adherence was measured as the proportion of patients without red flags who were not recommended for radiography.

RESULTS:   Of the 503 eligible patients, 448 (89.1%) agreed to participate in the study. Radiography was recommended for 12.3% of patients. According to the selected radiography guidelines, the proportion of patients with red flags ranged from 45.3% to 70.5%. The proportion of patients without red flags who were not recommended for radiography ranged from 89.4% (95% confidence interval, 85.5%-93.2%) to 94.7% (95% confidence interval, 90.9%-98.5%) for the selected guidelines.

CONCLUSION:   The results suggest a strong adherence to radiography guidelines for patients with a new episode of low back pain who presented to chiropractic teaching clinics. Although a high proportion of patients had red flags, radiography utilization was lower than rates reported in previous studies suggesting that adherence to guidelines may help prevent unnecessary radiography.

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