Implementing Evidence-Based Guidelines for Radiography in Acute Low Back Pain: A Pilot Study in a Chiropractic Community

Radiograph utilization and demographics in a chiropractic college teaching clinic

“…[9][10][11] Opponents of routine imaging argue its limited value, cost, and harm, 9,10 whereas proponents suggest that it may reveal underlying issues of concern, 1,12 may allow for better care, 11 or may provide useful information with less exposure to ionizing radiation compared with a computed tomographic scan 13 and significantly less cost than computed tomography or magnetic resonance imaging. 14 According to the 2010 National Board of Chiropractic Examiners Chiropractic Practice Analysis, 15 chiropractors review more radiographs than they take or order, and take radiographs on a weekly basis to rule out fracture, dislocation, or pathology.…”

Diagnostic Imaging Guidelines Implementation Study for Spinal Disorders: A Randomized Trial with Postal Follow-ups*

“…In a quasi-experimental method comparing outcomes before and after the educational intervention with those of a control community, a significant reduction in self-reported need for plain radiography for uncomplicated acute low back pain (LBP) and for patients with acute LBP of less than 1 month was seen in the intervention community compared to controls. 19 The interventions in that study included the following strategies: focus group session, workshop meeting, handout material (key research papers), decision aid tool (checklist for xray use), one-on-one meeting with researcher, and news release (educating public). Unfortunately, the size of the audience, time constraints, long distance, and budget constraints prevented several of the strategies found useful in the study by Ammendolia et al 19 from being applied to the current study.…”

“…19 The interventions in that study included the following strategies: focus group session, workshop meeting, handout material (key research papers), decision aid tool (checklist for xray use), one-on-one meeting with researcher, and news release (educating public). Unfortunately, the size of the audience, time constraints, long distance, and budget constraints prevented several of the strategies found useful in the study by Ammendolia et al 19 from being applied to the current study. Chiropractic students undergo extensive training in the field of radiology in all accredited colleges.…”

“…17 Among a group of chiropractors, an educational intervention strategy emphasizing the use of evidence-based diagnostic imaging guidelines was shown to decrease the perceived need for plainfilm radiography in uncomplicated low back pain patients in specific case scenarios. 19 Furthermore, information recall has been shown to be important in achieving behavior change in interventions providing information, 20 and "online" support may be an effective way to deliver reminders. 21 Rationale for selecting these interventions is further discussed in the latter part of this article.…”

Diagnostic Imaging Practice Guidelines for Musculoskeletal Complaints in Adults—An Evidence-Based Approach: Introduction

“…Most chiropractors obtain radiographs for clinical reasons, such as confirming a diagnosis of pathology, but many continue to use radiography as a screening tool and for medicolegal protection. 27,94 The frequency of conventional radiograph utilization by chiropractors for LBP complaints ranged from 60% to 90% in North America, [95][96][97] but many of the reasons provided by chiropractors for taking radiographs are not supported by the literature. 27,94,98 Recent surveys, however, suggest a significant decrease in reported frequency over time, 99 with, for example, 17% and 6% of Arizona and Massachusetts patient visits involving radiography, respectively.…”