Survey of plain film radiography protocols taught at chiropractic schools for acute low-back pain

Carlo Ammendolia, John Taylor, Victoria Pennick, Sheilah Hogg-Johnson, Claire Bombardier

Background: Studies of chiropractors in Europe and North America suggest a high utilization rate of plain film radiography to assess patients with acute low-back pain (LBP). This is contrary to current evidence, which suggests that plain film radiography is of limited value in this patient population. Unnecessary radiography is associated with high cost and potential risks. Radiology instruction at chiropractic schools may contribute to this gap between evidence and practice. Objectives: The main objective of this study was to assess the degree to which radiology departments of chiropractic schools in North America and Europe teach evidence-based protocols for the use of plain film radiography for assessing patients with acute LBP. The project also assessed the attitudes and beliefs toward evidence-based practice and the use of clinical practice guidelines among radiologists employed by chiropractic schools.
Methods: Surveys were distributed during an international conference for chiropractic radiologists employed by chiropractic schools. Completed surveys were analyzed using descriptive statistics.
Results: Of the 26 chiropractic schools in North America and Europe, 16 (62%) were represented at the conference. All 16 representatives completed the survey. Only one in 16 radiologists recommended the use of routine radiography prior to initiating treatment. For patients who present with acute LBP, 11 out of 16 (69%) radiologists instruct their students to use plain radiography only in the presence of “red flags”; two instruct, in addition to the presence of “red flags”, to consider radiography in workers’ compensation claims and/or to protect against malpractice; and the remaining three instruct, in addition to all of the above, that radiography should also be used to screen for contraindication to spinal manipulation and to identify the causative spinal lesion (misalignment/subluxation). Only one in 16 radiologists included oblique views as standard views for assessing LBP patients and two in 16 suggested that full spine radiography has a role in assessing patients with LBP. Evidence-based guidelines were considered useful for the management of acute LBP among 12 out the 15 (80%) radiologists who responded.
Conclusions: The vast majority of radiology departments of chiropractic colleges surveyed teach evidence-based protocols for the use of plain film radiography for patients with acute LBP.
References: 1. Plamindon RL. Summary of 1994 ACA statistical study. Am J Chiropractic. 1995;32;57-63. 2. Petersen P. A Survey of Chiropractic Practice in Europe. Eur J Chiropractic 1994; 42, pp. 3-28 3. Bigos SJ, Bowyer OR, Braen GR, Brown K, Deyo R, Haldeman S. Clinical Practice Guidelines No. 14. Rockville, MD: Agency for Health Care Policy And Research, Public Health Service, US Dept. Of Health and Health Services: 1994

Ottawa 2004 P-005