Bussières André E, Taylor John A M, Peterson Cynthia
Chiropractic Department, Université du Québec à Trois-Rivières, Quebec, Canada.
J Manipulative Physiol Ther. 2008 Jan;31(1):33-88. doi: 10.1016/j.jmpt.2007.11.003.
To develop evidence-based diagnostic imaging practice guidelines to assist chiropractors and other primary care providers in decision making for the appropriate use of diagnostic imaging for spinal disorders.
A comprehensive search of the English and French language literature was conducted using a combination of subject headings and keywords. The quality of the citations was assessed using the Quality of diagnostic accuracy studies (QUADAS), the Appraisal of Guidelines Research and Evaluation (AGREE), and the Stroke Prevention and Educational Awareness Diffusion (SPREAD) evaluation tools. The Referral Guidelines for Imaging (radiation protection 118) coordinated by the European Commission served as the initial template. The first draft was sent for an external review. A Delphi panel composed of international experts on the topic of musculoskeletal disorders in chiropractic radiology, clinical sciences, and research were invited to review and propose recommendations on the indications for diagnostic imaging. The guidelines were pilot tested and peer reviewed by practicing chiropractors, and by chiropractic and medical specialists. Recommendations were graded according to the strength of the evidence.
Recommendations for diagnostic imaging guidelines of adult spine disorders are provided, supported by more than 385 primary and secondary citations. The overall quality of available literature is low, however. On average, 45 Delphi panelists completed 1 of 2 rounds, reaching more than 85% agreement on all 55 recommendations. Peer review by specialists reflected high levels of agreement, perceived ease of use of guidelines, and implementation feasibility. Dissemination and implementation strategies are discussed.
The guidelines are intended to be used in conjunction with sound clinical judgment and experience and should be updated regularly. Future research is needed to validate their content.
制定基于证据的诊断成像实践指南，以协助脊椎按摩师和其他初级保健提供者在针对脊柱疾病合理使用诊断成像时进行决策。
结合主题词和关键词对英语和法语文献进行全面检索。使用诊断准确性研究质量（QUADAS）、指南研究与评价评估（AGREE）以及中风预防与教育意识传播（SPREAD）评估工具对文献引用质量进行评估。由欧盟委员会协调的《成像转诊指南》（辐射防护118）作为初始模板。初稿被送交外部评审。邀请了一个由脊椎按摩放射学、临床科学和研究领域的肌肉骨骼疾病主题国际专家组成的德尔菲小组，对诊断成像的适应症进行审查并提出建议。这些指南在执业脊椎按摩师以及脊椎按摩和医学专家中进行了试点测试和同行评审。建议根据证据强度进行分级。
提供了成人脊柱疾病诊断成像指南的建议，有超过385条一次和二次引用作为支撑。然而，现有文献的整体质量较低。平均而言，45名德尔菲小组成员完成了两轮中的一轮，对所有55条建议达成了超过85%的共识。专家的同行评审反映出高度的一致性、对指南易用性的认知以及实施的可行性。讨论了传播和实施策略。
这些指南旨在与合理的临床判断和经验结合使用，并应定期更新。需要未来的研究来验证其内容。
