Radiographic Anomalies That May Alter Chiropractic Intervention Strategies Found in a New Zealand Population

Ammendolia, Carlo

doi:10.1016/j.jmpt.2005.04.013

Cited by 6 publications

(3 citation statements)

References 6 publications

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“…Although evidence-based diagnostic imaging guidelines for spinal disorders are available [14-16], chiropractors are divided on whether these guidelines apply to them [5,17-20]. Wide variations in lumbar spine x-ray ordering have been reported in North America, ranging from 12% to 26% of patients presenting with low back pain [18,21-23] to well over 55% [5,6,24-27].…”

Section: Introductionmentioning

confidence: 99%

Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework

et al. 2012

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BackgroundThe Theoretical Domains Framework (TDF) was developed to investigate determinants of specific clinical behaviors and inform the design of interventions to change professional behavior. This framework was used to explore the beliefs of chiropractors in an American Provider Network and two Canadian provinces about their adherence to evidence-based recommendations for spine radiography for uncomplicated back pain. The primary objective of the study was to identify chiropractors’ beliefs about managing uncomplicated back pain without x-rays and to explore barriers and facilitators to implementing evidence-based recommendations on lumbar spine x-rays. A secondary objective was to compare chiropractors in the United States and Canada on their beliefs regarding the use of spine x-rays.MethodsSix focus groups exploring beliefs about managing back pain without x-rays were conducted with a purposive sample. The interview guide was based upon the TDF. Focus groups were digitally recorded, transcribed verbatim, and analyzed by two independent assessors using thematic content analysis based on the TDF.ResultsFive domains were identified as likely relevant. Key beliefs within these domains included the following: conflicting comments about the potential consequences of not ordering x-rays (risk of missing a pathology, avoiding adverse treatment effects, risks of litigation, determining the treatment plan, and using x-ray-driven techniques contrasted with perceived benefits of minimizing patient radiation exposure and reducing costs; beliefs about consequences); beliefs regarding professional autonomy, professional credibility, lack of standardization, and agreement with guidelines widely varied ( social/professional role & identity); the influence of formal training, colleagues, and patients also appeared to be important factors ( social influences); conflicting comments regarding levels of confidence and comfort in managing patients without x-rays ( belief about capabilities); and guideline awareness and agreements ( knowledge).ConclusionsChiropractors’ use of diagnostic imaging appears to be influenced by a number of factors. Five key domains may be important considering the presence of conflicting beliefs, evidence of strong beliefs likely to impact the behavior of interest, and high frequency of beliefs. The results will inform the development of a theory-based survey to help identify potential targets for behavioral-change strategies.

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Section: Introductionmentioning

confidence: 99%

Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework

et al. 2012

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“…2 The use of radiography in chiropractic practice has been controversial, both within and outside the profession, since it was first introduced in 1910. [3][4][5][6][7] This is particularly true for the use of radiography for low back pain, [8][9][10] which is the most common complaint seen by chiropractors. [11][12][13] Evidence-based guidelines for the management of low back pain recommend using radiography only in the presence of clinical indicators ("red flags") suggestive of underlying serious disease.…”

mentioning

confidence: 99%

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

Ammendolia

Taylor

Pennick

et al. 2008

Journal of Manipulative and Physiological Therapeutics

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“…[112][113][114][115][116][117][118][119][120][121] In addition, the answer to the above question (regarding the use of an index test for detecting a target condition) has not been adequately provided by proponents of the routine use of imaging studies to justify its use in screening to determine the presence of chiropractic subluxations or to prevent serious complications before spinal manipulative therapy. 122,123 Experimental evidence regarding the very nature of the subluxation syndrome still appears to be lacking. 124,125 Clearly, well-designed prospective studies are needed to help answer many of these questions.…”

Section: Type Of Practicementioning

confidence: 99%

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

Bussières

Peterson

Taylor

2007

Journal of Manipulative and Physiological Therapeutics

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Radiographic Anomalies That May Alter Chiropractic Intervention Strategies Found in a New Zealand Population

Cited by 6 publications

References 6 publications

Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework

Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework

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

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

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