Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study
Abstract Background Diagnostic imaging is useful for assessing low back pain (LBP) when a clinician suspects a specific underlying pathology. Evidence-based imaging guidelines assist clinicians in appropriately determining the need for imaging when assessing LBP. A previous study reported high adher...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | Chiropractic & Manual Therapies |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12998-022-00447-z |
| _version_ | 1818021982025809920 |
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| author | Ali Smith Varsha Kumar Jeffrey Cooley Carlo Ammendolia Joyce Lee Sheilah Hogg-Johnson Silvano Mior |
| author_facet | Ali Smith Varsha Kumar Jeffrey Cooley Carlo Ammendolia Joyce Lee Sheilah Hogg-Johnson Silvano Mior |
| author_sort | Ali Smith |
| collection | DOAJ |
| description | Abstract Background Diagnostic imaging is useful for assessing low back pain (LBP) when a clinician suspects a specific underlying pathology. Evidence-based imaging guidelines assist clinicians in appropriately determining the need for imaging when assessing LBP. A previous study reported high adherence to three clinical guidelines, with utilization rate of 12.3% in imaging of LBP patients attending a chiropractic teaching clinic. A new imaging guideline for spinal disorders has been published and used in teaching. Thus, the aims of our study were to assess the adherence to the new guideline and X-ray utilization in new episodes of LBP. Methods We conducted a historical clinical cohort study using patient electronic health record audits at seven teaching clinics over a period of 20 months. Records of patients who were at least 18 years of age, presented with a new onset of LBP, and consented to data collection were included. Abstracted data included patient demographics, the number and type of red flags, and the decision to image. Rate of guideline adherence (proportion of those not recommended for imaging, given no red flags) and rate of image utilization were descriptively analyzed. Results We included 498 patients in this study. At least 81% of included patients had one or more red flags reported. The most commonly reported individual red flag was age ≥ 50 (43.8%) followed by pain at rest (15.7%). In those referred for imaging, age ≥ 50 (93.3%) was the most frequently reported red flag. No red flag(s) were identified in 93 patient records, and none were referred for imaging of their LBP, yielding an adherence rate of 100% (95% CI 96, 100%). A total of 17 of 498 patients were recommended for imaging for their low back pain, resulting in an imaging utilization rate of 3.4% (95% CI 1.8, 5.0%). Conclusion The imaging utilization rate was 3.4%, lower than 12.3% previously reported at a chiropractic teaching clinic. None without red flags were referred for imaging, yielding a 100%, adherence rate to current LBP imaging guidelines. Future research should consider currency of guideline, accuracy of red flags and factors influencing clinicians’ decision, when assessing imaging adherence rates. |
| first_indexed | 2024-04-14T08:25:32Z |
| format | Article |
| id | doaj.art-9e59875fe0db4690a21e81874e64ab1e |
| institution | Directory Open Access Journal |
| issn | 2045-709X |
| language | English |
| last_indexed | 2024-04-14T08:25:32Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Chiropractic & Manual Therapies |
| spelling | doaj.art-9e59875fe0db4690a21e81874e64ab1e2022-12-22T02:04:04ZengBMCChiropractic & Manual Therapies2045-709X2022-09-0130111110.1186/s12998-022-00447-zAdherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort studyAli Smith0Varsha Kumar1Jeffrey Cooley2Carlo Ammendolia3Joyce Lee4Sheilah Hogg-Johnson5Silvano Mior6Canadian Memorial Chiropractic College (CMCC)Canadian Memorial Chiropractic College (CMCC)College of Science, Health, Engineering and Education, Murdoch UniversityRebecca MacDonald Center for Arthritis and Autoimmune Disease, Mount Sinai HospitalCanadian Memorial Chiropractic College (CMCC)Canadian Memorial Chiropractic College (CMCC)Canadian Memorial Chiropractic College (CMCC)Abstract Background Diagnostic imaging is useful for assessing low back pain (LBP) when a clinician suspects a specific underlying pathology. Evidence-based imaging guidelines assist clinicians in appropriately determining the need for imaging when assessing LBP. A previous study reported high adherence to three clinical guidelines, with utilization rate of 12.3% in imaging of LBP patients attending a chiropractic teaching clinic. A new imaging guideline for spinal disorders has been published and used in teaching. Thus, the aims of our study were to assess the adherence to the new guideline and X-ray utilization in new episodes of LBP. Methods We conducted a historical clinical cohort study using patient electronic health record audits at seven teaching clinics over a period of 20 months. Records of patients who were at least 18 years of age, presented with a new onset of LBP, and consented to data collection were included. Abstracted data included patient demographics, the number and type of red flags, and the decision to image. Rate of guideline adherence (proportion of those not recommended for imaging, given no red flags) and rate of image utilization were descriptively analyzed. Results We included 498 patients in this study. At least 81% of included patients had one or more red flags reported. The most commonly reported individual red flag was age ≥ 50 (43.8%) followed by pain at rest (15.7%). In those referred for imaging, age ≥ 50 (93.3%) was the most frequently reported red flag. No red flag(s) were identified in 93 patient records, and none were referred for imaging of their LBP, yielding an adherence rate of 100% (95% CI 96, 100%). A total of 17 of 498 patients were recommended for imaging for their low back pain, resulting in an imaging utilization rate of 3.4% (95% CI 1.8, 5.0%). Conclusion The imaging utilization rate was 3.4%, lower than 12.3% previously reported at a chiropractic teaching clinic. None without red flags were referred for imaging, yielding a 100%, adherence rate to current LBP imaging guidelines. Future research should consider currency of guideline, accuracy of red flags and factors influencing clinicians’ decision, when assessing imaging adherence rates.https://doi.org/10.1186/s12998-022-00447-zLow back painRadiographsChiropracticGuidelinesAdherenceRed flags |
| spellingShingle | Ali Smith Varsha Kumar Jeffrey Cooley Carlo Ammendolia Joyce Lee Sheilah Hogg-Johnson Silvano Mior Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study Chiropractic & Manual Therapies Low back pain Radiographs Chiropractic Guidelines Adherence Red flags |
| title | Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study |
| title_full | Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study |
| title_fullStr | Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study |
| title_full_unstemmed | Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study |
| title_short | Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study |
| title_sort | adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a canadian chiropractic college a historical clinical cohort study |
| topic | Low back pain Radiographs Chiropractic Guidelines Adherence Red flags |
| url | https://doi.org/10.1186/s12998-022-00447-z |
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