Do chiropractors adhere to guidelines for back radiographs? A study of chiropractic teaching clinics in Canada.
METHODS
Clinical cohort.


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


BACKGROUND
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.


CONCLUSIONS
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.
Ammendolia
Carlo
C
Centre for Research Expertise in Improved Disability Outcomes, University Health Network, and Institute for Work & Health, University of Toronto, Toronto, Ontario, Canada. cammendo@uhnresearch.ca
Côté
Pierre
P
Hogg-Johnson
Sheilah
S
Bombardier
Claire
C
D000554:Ambulatory Care Facilities / Q000592:standards / Q000706:statistics & numerical data; D002170:Canada; D002684:Chiropractic / Q000193:education* / Q000592:standards*; D002982:Clinical Clerkship; D002983:Clinical Competence; D003657:Decision Making; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic / Q000592:standards*; D011787:Quality of Health Care; D011859:Radiography / Q000592:standards / Q000706:statistics & numerical data*; D018570:Risk Assessment; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology; D013131:Spine / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011795:Surveys and Questionnaires