Current evidence for spinal X-ray use in the chiropractic profession: a narrative review

Jenkins, Hazel; Downie, Aron; Moore, Craig; French, Simon

doi:10.1186/s12998-018-0217-8

Cited by 51 publications

(132 citation statements)

References 114 publications

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“…In the absence of "red flags", the use of spinal radiographs is not recommended [3][4][5][6][7]. Nevertheless, factions of chiropractors, including the International Chiropractic Association promote the use of routine or repeat radiographs to assess the structure and function of the spine [12][13][14]. This practice which dates back to 1910 was initiated when no evidence was available to guide the judicious use of spine radiographs [15].…”

Section: Introductionmentioning

confidence: 99%

The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature

et al. 2020

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Introduction: When indicated by signs or symptoms of potentially serious underlying pathology (red flags), chiropractors can use radiographs to inform their diagnosis. In the absence of red flags, the clinical utility of routine or repeat radiographs to assess the structure and function of the spine is controversial. Objectives: To determine the diagnostic and therapeutic utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. Investigate whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. The research objectives required that we determine the validity, diagnostic accuracy and reliability of radiographs for the structural and functional evaluation of the spine. Evidence review: We searched MEDLINE, CINAHL, and Index to Chiropractic Literature from inception to November 25, 2019. We used rapid review methodology recommended by the World Health Organization. Eligible studies (cross-sectional, case-control, cohort, randomized controlled trials, diagnostic and reliability) were critically appraised. Studies of acceptable quality were included in our synthesis. The lead author extracted data and a second reviewer independently validated the data extraction. We conducted a qualitative synthesis of the evidence. Findings: We identified 959 citations, screened 176 full text articles and critically appraised 23. No relevant studies assessed the clinical utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. No studies investigated whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. Nine low risk of bias studies investigated the validity (n = 2) and reliability (n = 8) of routine or repeat radiographs. These studies provide no evidence of clinical utility. Conclusion: We found no evidence that the use of routine or repeat radiographs to assess the function or structure of the spine, in the absence of red flags, improves clinical outcomes and benefits patients. Given the inherent risks of ionizing radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine.

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Section: Introductionmentioning

confidence: 99%

The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature

et al. 2020

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“…Papers in this series have again revealed deeply rooted disagreements within the chiropractic profession about what chiropractic is, and what it should be, as a profession [13,19,20], as well as disagreements and variation in relation to education of chiropractors [14,15] and chiropractic clinical practice [11]. In our opinion, it is ironic that while chiropractic has a strong presence in large parts of the world [3], is taking on increasingly important roles in disability prevention [6,7,17], in the military [5] and in interprofessional care [8] as well as growing research capacity [16], discussions about fundamental values and direction of the profession are unresolved.…”

Section: Discussionmentioning

confidence: 99%

“…Axén et al systematically reviewed evidence pertaining to chiropractic maintenance care and concluded that significant advances had been made in recent decades regarding what maintenance care is, when it should be applied, and what outcomes to expect [10]. Jenkins et al reviewed practice guidelines dealing with use of spinal x-ray in chiropractic practice and concluded that routine use of x-ray is not in accordance with current evidence and practice guidelines [11]. Hansen et al reported that chiropractors (at least in Denmark), when surveyed, commonly reported workrelated physical acute or overuse injuries in the low back, wrist, thumb and shoulder, but were very satisfied with their job and had a good psychosocial work environment [12].…”

Section: Commentarymentioning

confidence: 99%

So, what is chiropractic? Summary and reflections on a series of papers in Chiropractic and Manual Therapies

Hartvigsen

French

2020

Chiropr Man Therap

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This commentary brings the 2017-2019 thematic series What is Chiropractic? to a close. The 18 papers published in the series contribute to a better understanding of what chiropractic is, where chiropractors practice and function, who seeks their care, what chiropractors do, and how they interact with other healthcare professionals. Several papers in the series highlighted deeply rooted disagreements within chiropractic about fundamental issues pertaining to ideology, acceptance of scientific evidence as the basis for clinical practice and the future of chiropractic. If the chiropractic profession is to remain relevant in today's evidence-based healthcare environment, there is an urgent for the profession to undertake further research to describe what chiropractic is, what chiropractors do, and provide evidence for the value of these activities to patients and healthcare decision makers.

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“…This limitation was most pronounced for the topic of diagnostic imaging, where there is still a lack of literature specifically addressing the use of imaging for the purposes of manual care. 82,83 We expect this gap to be increasingly addressed in the future; in fact, an article addressing the topic was published just after we completed the consensus process for this project. 83 Another limitation may be perceived as the composition of our Delphi panel, which was exclusively DCs, although some were cross-trained in other disciplines.…”

Section: Limitationsmentioning

confidence: 99%

“…82,83 We expect this gap to be increasingly addressed in the future; in fact, an article addressing the topic was published just after we completed the consensus process for this project. 83 Another limitation may be perceived as the composition of our Delphi panel, which was exclusively DCs, although some were cross-trained in other disciplines. However, the composition was planned this way because we intended the recommendations to be used by DCs.…”

Section: Limitationsmentioning

confidence: 99%

Best-Practice Recommendations for Chiropractic Management of Patients With Neck Pain

Whalen

Farabaugh²,

Hawk

et al. 2019

Journal of Manipulative and Physiological Therapeutics

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Objective: The purpose of this study was to develop best-practice recommendations for chiropractic management of adults with neck pain. Methods: A steering committee of experts in chiropractic practice, education, and research drafted a set of recommendations based on the most current relevant clinical practice guidelines. Additional supportive literature was identified through targeted searches conducted by a health sciences librarian. A national panel of chiropractors representing expertise in practice, research, and teaching rated the recommendations using a modified Delphi process. The consensus process was conducted from August to November 2018. Fifty-six panelists rated the 50 statements and concepts and reached consensus on all statements within 3 rounds. Results: The statements and concepts covered aspects of the clinical encounter, ranging from informed consent through diagnosis, assessment, treatment planning and implementation, and concurrent management and referral for patients presenting with neck pain. Conclusions: These best-practice recommendations for chiropractic management of adults with neck pain are based on the best available scientific evidence. For uncomplicated neck pain, including neck pain with headache or radicular symptoms, chiropractic manipulation and multimodal care are recommended.

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Current evidence for spinal X-ray use in the chiropractic profession: a narrative review

Cited by 51 publications

References 114 publications

The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature

The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature

So, what is chiropractic? Summary and reflections on a series of papers in Chiropractic and Manual Therapies

Best-Practice Recommendations for Chiropractic Management of Patients With Neck Pain

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