title: Management of people with acute low-back pain: a survey of Australian chiropractors.
abstract: BACKGROUND
  Chiropractors commonly provide care to people with acute low-back pain (LBP). The aim of this survey was to determine how chiropractors intend to support and manage people with acute LBP and if this management is in accordance with two recommendations from an Australian evidence-based acute LBP guideline. The two recommendations were directed at minimising the use of plain x-ray and encouraging the patient to stay active.
  
  
  METHODS
  This is a cross sectional survey of chiropractors in Australia. This paper is part of the ALIGN study in which a targeted implementation strategy was developed to improve the management of acute LBP in a chiropractic setting. This implementation strategy was subsequently tested in a cluster randomised controlled trial. In this survey phase of the ALIGN study we approached a random sample of 880 chiropractors in three States of Australia. The mailed questionnaire consisted of five patient vignettes designed to represent people who would typically present to chiropractors with acute LBP. Four vignettes represented people who, according to the guideline, would not require a plain lumbar x-ray, and one vignette represented a person with a suspected vertebral fracture. Respondents were asked, for each vignette, to indicate which investigation(s) they would order, and which intervention(s) they would recommend or undertake.
  
  
  RESULTS
  Of the 880 chiropractors approached, 137 were deemed ineligible to participate, mostly because they were not currently practising, or mail was returned to sender. We received completed questionnaires from 274 chiropractors (response rate of 37%). Male chiropractors made up 66% of respondents, 75% practised in an urban location and their mean number of years in practice was 15. Across the four vignettes where an x-ray was not indicated 68% (95% Confidence Intervals (CI): 64%, 71%) of chiropractors responded that they would order or take an x-ray. In addition 51% (95%CI: 47%, 56%) indicated they would give advice to stay active when it was indicated. For the vignette where a fracture was suspected, 95% (95% CI: 91%, 97%) of chiropractors would order an x-ray.
  
  
  CONCLUSIONS
  The intention of chiropractors surveyed in this study shows low adherence to two recommendations from an evidence-based guideline for acute LBP. Quality of care for these patients could be improved through effective implementation of evidence-based guidelines. Further research to find cost-effective methods to increase implementation is warranted.
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia. s.french@unimelb.edu.au.
authors.forename: Bruce F
authors.initials: BF
authors.lastname: Walker
authors.forename: Simon D
authors.initials: SD
authors.lastname: French
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Page
authors.forename: Denise A
authors.initials: DA
authors.lastname: O'Connor
authors.forename: Joanne E
authors.initials: JE
authors.lastname: McKenzie
authors.forename: Katherine
authors.initials: K
authors.lastname: Beringer
authors.forename: Kerry
authors.initials: K
authors.lastname: Murphy
authors.forename: Jenny L
authors.initials: JL
authors.lastname: Keating
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Francis
authors.forename: Sally E
authors.initials: SE
authors.lastname: Green