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Knowledge of and adherence to radiographic guidelines for low back pain: a survey of chiropractors in Newfoundland and Labrador, Canada

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 ou...

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Autores principales: De Carvalho, Diana, Bussières, André, French, Simon D., Wade, Darrell, Brake-Patten, Debbie, O’Keefe, Lino, Elliott, Barbara, Budgell, Ken, O’Reilly, Sara, To, Daphne, Hall, Amanda
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812732/
https://www.ncbi.nlm.nih.gov/pubmed/33461555
http://dx.doi.org/10.1186/s12998-020-00361-2
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author De Carvalho, Diana
Bussières, André
French, Simon D.
Wade, Darrell
Brake-Patten, Debbie
O’Keefe, Lino
Elliott, Barbara
Budgell, Ken
O’Reilly, Sara
To, Daphne
Hall, Amanda
author_facet De Carvalho, Diana
Bussières, André
French, Simon D.
Wade, Darrell
Brake-Patten, Debbie
O’Keefe, Lino
Elliott, Barbara
Budgell, Ken
O’Reilly, Sara
To, Daphne
Hall, Amanda
author_sort De Carvalho, Diana
collection PubMed
description 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12998-020-00361-2.
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spelling pubmed-78127322021-01-19 Knowledge of and adherence to radiographic guidelines for low back pain: a survey of chiropractors in Newfoundland and Labrador, Canada De Carvalho, Diana Bussières, André French, Simon D. Wade, Darrell Brake-Patten, Debbie O’Keefe, Lino Elliott, Barbara Budgell, Ken O’Reilly, Sara To, Daphne Hall, Amanda Chiropr Man Therap Research 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12998-020-00361-2. BioMed Central 2021-01-18 /pmc/articles/PMC7812732/ /pubmed/33461555 http://dx.doi.org/10.1186/s12998-020-00361-2 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
De Carvalho, Diana
Bussières, André
French, Simon D.
Wade, Darrell
Brake-Patten, Debbie
O’Keefe, Lino
Elliott, Barbara
Budgell, Ken
O’Reilly, Sara
To, Daphne
Hall, Amanda
Knowledge of and adherence to radiographic guidelines for low back pain: a survey of chiropractors in Newfoundland and Labrador, Canada
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 Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812732/
https://www.ncbi.nlm.nih.gov/pubmed/33461555
http://dx.doi.org/10.1186/s12998-020-00361-2
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