Adherence to clinical practice guidelines for radiography use in low-back pain among chiropractic teaching clinics.
Published: 2005
Language: eng
Number of pages: 206
Description: There is consistent evidence that chiropractors have high utilization of radiography for patients with acute low-back pain. This is contrary to evidence-based guidelines which suggest that radiography is of limited value in this patient population. Radiography should be considered only in patients with "red flags" which are "signs and symptoms" suggestive of underlying serious disease.The purpose of this thesis is to investigate the apparent disparity between evidence and practice among chiropractors. The thesis consists of three research studies. The primary research study investigates how well chiropractic teaching clinics adhere to clinical guidelines for radiography use for a new episode of low-back pain, and whether the high use of radiography seen in practice begins during undergraduate training. The second study investigates radiography instruction among chiropractic schools world-wide, and the third study describes trends in use of lumbar and full spine radiography among Ontario chiropractors over a seven-year period.In the primary study, radiography use was assessed among 448 patients presenting to the teaching clinics of a Canadian chiropractic school with a new episode of low-back pain. This was compared to the radiography recommendations of three clinical guidelines. Each guideline recommends against the use of radiography in the absence of red flags for serious disease.A total of 12.3 per cent of eligible patients were recommended for radiography. The "red flag" rate among patients ranged from 45.3 to 70.5 per cent depending on the guideline used. Among patients without "red flags" for serious disease, 89.4, 93.3 and 94.7 per cent were not recommended for radiography based on the criteria of three selected guidelines respectively.Results of the second and third studies suggest a general adherence to current evidence for radiography use in low-back pain among chiropractic schools world-wide, and a decreasing trend in the use of lumbar and full spine radiography by Ontario chiropractors.The results suggest a high level of adherence to guidelines among the chiropractic teaching clinics for the use of radiography in a new episode of low back pain. Only a minority of patients were recommended for radiography. This is in contrast to previous studies of community chiropractors.
Notes: Source: Dissertation Abstracts International, Volume: 66-10, Section: B, page: 5352.

Thesis (Ph.D.)--University of Toronto, 2005.

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