Examining Clinical Opinion and Experience Regarding Utilization of Plain Radiography of the Spine: Evidence from Surveying the Chiropractic Profession

Abstract

Plain Radiography of the spine (PROTS) is utilized in many forms of healthcare including the chiropractic profession; however, the literature reflects conflicting opinions regarding utilization and value. Despite being an essential part of Evidence-Based Practice (EBP), few studies assess Doctors of Chiropractic (DCs) clinical opinions and experience regarding the utilization of (PROTS) in practice. In this study, DCs were surveyed regarding utilization of PROTS in practice. The survey was administered to an estimated 50,000 licensed DCs by email. A total of 4301 surveys were completed, of which 3641 were United States (US) DCs. The Clinician Opinion and Experience on Chiropractic Radiography (COECR) scale was designed to analyze survey responses. This valid and reliable scale demonstrated good internal consistency using confirmatory factor analysis and the Rasch model. Survey responses show that 73.3% of respondents utilize PROTS in practice and 26.7% refer patients out for PROTS. Survey responses show that, among US DCs, 91.9% indicate PROTS has value beyond identification of pathology, 86.7% indicate that PROTS is important regarding biomechanical analysis of the spine, 82.9% indicate that PROTS is vital to practice, 67.4% indicate that PROTS aids in measuring outcomes, 98.6% indicate the opinion that PROTS presents very low to no risk to patients, and 93.0% indicate that sharing clinical findings from PROTS studies with patients is beneficial to clinical outcomes. The results of the study indicated that based on clinical experience, the majority of DCs find PROTS to be vital to practice and valuable beyond the identification of red flags.

Don’t Throw the ‘Bio’ out of the Bio-Psycho-Social Model: Editorial for Spine Rehabilitation in 2022 and Beyond

“…At the time of the writing of this Editorial, there were 15 unique manuscripts accepted for publication in the Special Issue: Spine Rehabilitation in 2022 and Beyond. These manuscripts include the following categories of articles: a cross-sectional survey comparing two distinct quality of life questionnaires in adults with scoliosis [46]; a retrospective consecutive cohort investigation examining the relationship of vertebral y-axis rotation of the lumbar spine in functional scoliosis with leg length inequality to sacral shelf lateral tilt angles [47]; a profession wide survey of the chiropractic profession regarding spine radiography utilization examining clinical opinions and experience [48]; a novel clinical manual method comparing manual palpation and motion vs. diagnostic imaging to determine pathological rotational instability movement of the upper cervical spine [49]; four case-control investigations seeking to identify any correlations between spine and posture displacements and patient pain, disability, neurophysiology, and sensory-motor control variables [50][51][52][53]; one case series looking at the relationship between non-surgical sagittal plane cervical spine correction and the improvement in upper cervical spine rotational instability [54]; five randomized trials examining the relationship between correction/reduction of cervical and thoracic posture deformities and spine displacements and improvements of a variety of clinical outcome measures including pain, disability, neurophysiology, range of motion, and sensory-motor control measures [55][56][57][58][59]; and, lastly, one systematic literature review that sought to understand the differences in low back pain and disability characteristics in adults with and without scoliotic spine deformities [60].…”

“…Importantly, each one of these 15 accepted manuscripts offers unique and succinct relevant data that provide further evidence that the 'bio' (biology and biomechanics) component of the 'bio-psycho-social' model of spine care is extremely important to understanding patient pain, disability, and dysfunction and to providing enhanced treatment procedures that improve the outcomes of patient care [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]. As such, this Special Issue on spine rehabilitation provides useful, cutting-edge, relevant information that should prove to be useful to improve patient care and outcomes in populations suffering from a wide variety of spine related disorders.…”

“…We thank all the authors of each of these manuscripts for their work, dedication, and insights they provided to bring their team's data together in an effective scientific manner. We are confident that each of the manuscripts contained in this collection will be well cited and used by future clinicians from many disciplines and researchers to treat patients around the globe and to improve upon the information presented [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60].…”

Chiropractors’ perceptions on the use of spinal radiographs in clinical practice: a qualitative study

“…While some chiropractors primarily use radiographs to rule out serious pathology and trauma, which is in line with CPGs [ 9 , 17 ], others consider such recommendations to be too restrictive. Some chiropractors suggest that radiographs are additionally necessary in the assessment of structural misalignment, to determine/guide appropriate treatment, and to identify clinically unsuspected contraindications to management [ 18 , 19 ]. For example, a survey of United States (US) chiropractors reported that 87% of chiropractors thought obtaining radiographs for biomechanical analysis has significant value, and 72% of chiropractors reported using radiographs to determine where and how to perform spinal manipulation (SM) [ 19 ].…”

“…Some chiropractors suggest that radiographs are additionally necessary in the assessment of structural misalignment, to determine/guide appropriate treatment, and to identify clinically unsuspected contraindications to management [ 18 , 19 ]. For example, a survey of United States (US) chiropractors reported that 87% of chiropractors thought obtaining radiographs for biomechanical analysis has significant value, and 72% of chiropractors reported using radiographs to determine where and how to perform spinal manipulation (SM) [ 19 ]. Similarly, in Australia, approximately one-third of chiropractors mentioned that they would refer for radiographs to perform biomechanical analyses, and approximately two-thirds stated that they would use radiographs to assess patients for less serious conditions (e.g., spinal curve changes, spondylolisthesis, or degeneration) [ 20 ].…”