Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada.
School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada.
Chiropr Man Therap. 2021 Jan 18;29(1):4. doi: 10.1186/s12998-020-00361-2.
Low back pain (LBP) rarely requires routine imaging of the lumbar spine in the primary care setting, as serious spinal pathology is rare. Despite evidence-based clinical practice guidelines recommending delaying imaging in the absence of red flags, chiropractors commonly order imaging outside of these guidelines. The purpose of this study was to survey chiropractors to determine the level of knowledge, adherence to, and beliefs about, clinical practice guidelines related to the use of lumbar radiography for LBP in Newfoundland and Labrador (NL), Canada.
A cross-sectional survey of chiropractors in NL (n = 69) was conducted between May and June 2018, including questions on demographics, awareness of radiographic guidelines, and beliefs about radiographs for LBP. We assessed behavioural simulation using clinical vignettes to determine levels of adherence to LBP guideline recommendations.
The response rate was 77% (n = 53). Half of the participants stated they were aware of current radiographic guideline recommendations, and one quarter of participants indicated they did not use guidelines to inform clinical decisions. The majority of participants agreed that x-rays of the lumbar spine are useful for patients with suspected pathology, are indicated when a patient is non-responsive to 4 weeks of conservative treatment for LBP, and when there are neurological signs associated with LBP. However, a small proportion indicated that there is a role for full spine x-rays (~ 21%), x-rays to evaluate patients with acute LBP (~ 13%), and that patient expectations play a role in decision making (4%). Adherence rate to radiographic guidelines measured using clinical vignettes was 75%.
While many chiropractors in this sample reported being unsure of specific radiographic guidelines, the majority of respondents adhered to guideline recommendations measured using clinical vignettes. Nonetheless, a small proportion still hold beliefs about radiographs for LBP that are discordant with current radiographic guidelines. Future research should aim to determine barriers to guideline uptake in this population in order to design and evaluate tailored knowledge translation strategies to reduce unnecessary LBP imaging.
在初级保健环境中，腰痛（LBP）很少需要常规对腰椎进行影像学检查，因为严重的脊柱病变很少见。尽管有循证临床实践指南建议在没有危险信号的情况下延迟影像学检查，但脊医通常会在这些指南之外进行影像学检查。本研究的目的是调查脊医，以确定他们对加拿大纽芬兰和拉布拉多（NL）与 LBP 腰椎 X 射线使用相关的临床实践指南的了解程度、遵守程度和信念。
2018 年 5 月至 6 月期间对 NL 的脊医进行了横断面调查（n=69），包括人口统计学问题、对放射学指南的认识以及对 LBP 放射学的看法。我们使用临床病例来评估行为模拟，以确定对 LBP 指南建议的遵守程度。
回应率为 77%（n=53）。一半的参与者表示他们了解当前的放射学指南建议，四分之一的参与者表示他们不使用指南来指导临床决策。大多数参与者认为腰椎 X 射线对疑似有病变的患者有用，当患者对 4 周的 LBP 保守治疗无反应时，或当 LBP 伴有神经体征时，X 射线是有必要的。然而，一小部分人表示全脊柱 X 射线（21%）、评估急性 LBP 患者的 X 射线（13%）有作用，并且患者的期望在决策中起作用（4%）。使用临床病例评估的放射学指南的遵守率为 75%。
尽管本研究样本中的许多脊医表示不确定具体的放射学指南，但大多数受访者在使用临床病例时都遵守了指南建议。尽管如此，一小部分人仍然对 LBP 射线持与当前放射学指南不一致的看法。未来的研究应旨在确定该人群中采用指南的障碍，以便设计和评估有针对性的知识转化策略，以减少不必要的 LBP 影像学检查。
