Adherence to Radiography Guidelines for Low Back Pain: A Survey of Chiropractic Schools Worldwide

Received 1 November 2007; received in revised form 3 January 2008; accepted 7 January 2008.

Abstract

Objective

This study describes instruction provided at chiropractic schools worldwide on the use of spine radiography and compares instruction with evidence-based guidelines for low back pain.

Methods

Individuals responsible for radiology instruction at accredited chiropractic schools throughout the world were contacted and invited to participate in a Web-based survey. The survey included questions on the role of conventional radiography in chiropractic practice and instruction given to students for its use in patients with acute low back pain.

Results

Of the 33 chiropractic schools identified worldwide, 32 (97%) participated in the survey. Consistent with the guidelines, 25 (78%) respondents disagreed that “routine radiography should be used prior to spinal manipulative therapy,” 29 (91%) disagreed that there “was a role for full spine radiography for assessing patients with low back pain,” and 29 (91%) disagreed that “oblique views should be part of a standard radiographic series for low back pain.” However, only 14 (44%) respondents concurred with the guidelines and disagreed with the statement that there “is a role for radiography in acute low back pain in the absence of ‘red flags’ for serious disease.”

Conclusions

This survey suggests that many aspects of radiology instruction provided by accredited chiropractic schools appear to be evidence based. However, there appears to be a disparity between some schools and existing evidence with respect to the role of radiography for patients with acute low back pain without “red flags” for serious disease. This may contribute to chiropractic overutilization of radiography for low back pain.

Key Indexing Terms: Public health, Chiropractic

a Clinical Epidemiologist, Rehabilitation Solutions, University Health Network, Toronto, Ontario, Canada; Scientist, Centre for Research Expertise in Improved Disability Outcomes (CREIDO), University Health Network, Toronto, Ontario Canada; Adjunct Scientist, Institute for Work and Health, University of Toronto, Toronto, Ontario, Canada

b Professor and Coordinator of Diagnostic Imaging, New York Chiropractic College, Seneca Falls, New York; Doctor of Chiropractic Program, D'Youville College, Buffalo, New York

c Senior Clinical Research Project Manager, Institute for Work and Health, University of Toronto, Toronto, Ontario, Canada

d Scientist, Centre for Research Expertise in Improved Disability Outcomes (CREIDO), University Health Network, Toronto, Ontario, Canada; Institute for Work and Health, University of Toronto, Toronto, Ontario, Canada; Associate Professor, Department of Public Health Sciences Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

e Senior Scientist, Institute for Work and Health, University of Toronto, Toronto, Ontario, Canada; Assistant Professor, Department of Public Health Sciences Faculty of Medicine, University of Toronto, Ontario, Canada

f Senior Scientist, Institute for Work and Health, University of Toronto, Toronto, Ontario, Canada; Professor, Faculty of Medicine University of Toronto, Division of Rheumatology, University of Toronto, Ontario, Canada; Director, Clinical Decision-Making and Health Care Division, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada

g Clinical Decision-Making and Health Care Division, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada

Submit requests for reprints to: Carlo Ammendolia, DC, PhD, Centre for Research Expertise in Improved Disability Outcomes, Toronto Western Hospital–University health Network, Fell Pavilion 4-132399 Bathurst St, Toronto, Ontario, Canada M5T 2S8

PII: S0161-4754(08)00173-5

doi:10.1016/j.jmpt.2008.06.010

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