Knowledge of and adherence to radiographic guidelines for low back pain: a survey of chiropractors in Newfoundland and Labrador, Canada
Abstract 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 im...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-01-01
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| Series: | Chiropractic & Manual Therapies |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12998-020-00361-2 |
| _version_ | 1818382615421386752 |
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| author | Diana De Carvalho André Bussières Simon D. French Darrell Wade Debbie Brake-Patten Lino O’Keefe Barbara Elliott Ken Budgell Sara O’Reilly Daphne To Amanda Hall |
| author_facet | Diana De Carvalho André Bussières Simon D. French Darrell Wade Debbie Brake-Patten Lino O’Keefe Barbara Elliott Ken Budgell Sara O’Reilly Daphne To Amanda Hall |
| author_sort | Diana De Carvalho |
| collection | DOAJ |
| description | Abstract 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 they were aware of current radiographic guideline recommendations, and one quarter of participants indicated they did not use guidelines to inform clinical decisions. The majority of participants agreed that x-rays of the lumbar spine are useful for patients with suspected pathology, are indicated when a patient is non-responsive to 4 weeks of conservative treatment for LBP, and when there are neurological signs associated with LBP. However, a small proportion indicated that there is a role for full spine x-rays (~ 21%), x-rays to evaluate patients with acute LBP (~ 13%), and that patient expectations play a role in decision making (4%). Adherence rate to radiographic guidelines measured using clinical vignettes was 75%. Conclusions While many chiropractors in this sample reported being unsure of specific radiographic guidelines, the majority of respondents adhered to guideline recommendations measured using clinical vignettes. Nonetheless, a small proportion still hold beliefs about radiographs for LBP that are discordant with current radiographic guidelines. Future research should aim to determine barriers to guideline uptake in this population in order to design and evaluate tailored knowledge translation strategies to reduce unnecessary LBP imaging. |
| first_indexed | 2024-12-14T02:53:17Z |
| format | Article |
| id | doaj.art-0ee5be85d4704b79a9f2a7301a573a2a |
| institution | Directory Open Access Journal |
| issn | 2045-709X |
| language | English |
| last_indexed | 2024-12-14T02:53:17Z |
| publishDate | 2021-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Chiropractic & Manual Therapies |
| spelling | doaj.art-0ee5be85d4704b79a9f2a7301a573a2a2022-12-21T23:19:41ZengBMCChiropractic & Manual Therapies2045-709X2021-01-0129111010.1186/s12998-020-00361-2Knowledge of and adherence to radiographic guidelines for low back pain: a survey of chiropractors in Newfoundland and Labrador, CanadaDiana De Carvalho0André Bussières1Simon D. French2Darrell Wade3Debbie Brake-Patten4Lino O’Keefe5Barbara Elliott6Ken Budgell7Sara O’Reilly8Daphne To9Amanda Hall10Division of Community Health and Humanities, Faculty of Medicine, Memorial University of NewfoundlandSchool of Physical and Occupational Therapy, McGill UniversityDepartment of Chiropractic, Macquarie UniversityPrivate PracticePrivate PracticePrivate PracticePatient Engagement PartnerPrivate PracticePrimary Healthcare Research Unit, Faculty of Medicine, Memorial University of NewfoundlandDivision of Community Health and Humanities, Faculty of Medicine, Memorial University of NewfoundlandPrimary Healthcare Research Unit, Faculty of Medicine, Memorial University of NewfoundlandAbstract 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 they were aware of current radiographic guideline recommendations, and one quarter of participants indicated they did not use guidelines to inform clinical decisions. The majority of participants agreed that x-rays of the lumbar spine are useful for patients with suspected pathology, are indicated when a patient is non-responsive to 4 weeks of conservative treatment for LBP, and when there are neurological signs associated with LBP. However, a small proportion indicated that there is a role for full spine x-rays (~ 21%), x-rays to evaluate patients with acute LBP (~ 13%), and that patient expectations play a role in decision making (4%). Adherence rate to radiographic guidelines measured using clinical vignettes was 75%. Conclusions While many chiropractors in this sample reported being unsure of specific radiographic guidelines, the majority of respondents adhered to guideline recommendations measured using clinical vignettes. Nonetheless, a small proportion still hold beliefs about radiographs for LBP that are discordant with current radiographic guidelines. Future research should aim to determine barriers to guideline uptake in this population in order to design and evaluate tailored knowledge translation strategies to reduce unnecessary LBP imaging.https://doi.org/10.1186/s12998-020-00361-2Diagnostic imagingLow back painGuidelinesKnowledge and beliefsChiropractors |
| spellingShingle | Diana De Carvalho André Bussières Simon D. French Darrell Wade Debbie Brake-Patten Lino O’Keefe Barbara Elliott Ken Budgell Sara O’Reilly Daphne To Amanda Hall Knowledge of and adherence to radiographic guidelines for low back pain: a survey of chiropractors in Newfoundland and Labrador, Canada Chiropractic & Manual Therapies Diagnostic imaging Low back pain Guidelines Knowledge and beliefs Chiropractors |
| title | Knowledge of and adherence to radiographic guidelines for low back pain: a survey of chiropractors in Newfoundland and Labrador, Canada |
| title_full | Knowledge of and adherence to radiographic guidelines for low back pain: a survey of chiropractors in Newfoundland and Labrador, Canada |
| title_fullStr | Knowledge of and adherence to radiographic guidelines for low back pain: a survey of chiropractors in Newfoundland and Labrador, Canada |
| title_full_unstemmed | Knowledge of and adherence to radiographic guidelines for low back pain: a survey of chiropractors in Newfoundland and Labrador, Canada |
| title_short | Knowledge of and adherence to radiographic guidelines for low back pain: a survey of chiropractors in Newfoundland and Labrador, Canada |
| title_sort | knowledge of and adherence to radiographic guidelines for low back pain a survey of chiropractors in newfoundland and labrador canada |
| topic | Diagnostic imaging Low back pain Guidelines Knowledge and beliefs Chiropractors |
| url | https://doi.org/10.1186/s12998-020-00361-2 |
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