Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, The Netherlands.
Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, The Netherlands; Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, Groningen, The Netherlands.
J Manipulative Physiol Ther. 2022 Jan;45(1):57-72. doi: 10.1016/j.jmpt.2022.03.008. Epub 2022 Jun 24.
The purpose of this study was (1) to describe diagnostic imaging in Dutch and Belgian chiropractic practice in general, (2) to estimate adherence to the diagnostic imaging guidelines for patients with low back pain (LBP) via vignettes, and (3) to evaluate factors associated with diagnostic imaging and adherence to the guidelines.
We used a web-based survey to collect sociodemographic data, practice characteristics, amount of imaging, opinions, and indications for requesting imaging from registered Dutch and Belgian chiropractors in 2013. Additionally, adherence to imaging guidelines for LBP was assessed by 6 vignettes in patients with LBP. Multivariable regression analyses were conducted to explore associations between characteristics of chiropractors and the use of imaging. Generalized mixed models were used to explore guidelines adherence and their relationship with chiropractor's characteristics.
The overall response rate was 60% (n = 203 out of 340). In total, 83% of chiropractors viewed diagnostic imaging in general as an important part of their practice. It is important to note that Dutch and Belgian chiropractors are not allowed to refer directly for imaging. Chiropractors reported that they would like to have imaging in 42% of their patients. Imaging had already been performed in 37% of patients before the first visit and was ordered by another health care provider (ie, general practitioner or medical specialist). The most common indication for ordering imaging was exclusion of contraindications (73%). The most common reason against imaging was the perceived limited value (45%). Many chiropractors (71%) were familiar with imaging guidelines. Adherence to the imaging guidelines for LBP based upon the vignettes was 66%. Dutch chiropractors and chiropractors with less than 10 years in practice demonstrated better adherence to guidelines and imaging use as compared with Belgian and those with more than 10 years of experience.
Most Dutch and Belgian chiropractors reported that imaging in general was important in chiropractic practice. Self-reported indications for ordering diagnostic imaging were in line with the imaging guidelines in the majority of cases. We found some variances between Belgian and Dutch chiropractors and years of experience related to guideline adherence.
本研究旨在：(1) 描述荷兰和比利时整脊实践中的诊断性影像学应用；(2) 通过病例描述评估对腰痛患者的影像学指南的遵从情况；(3) 评估与影像学使用和对指南遵从相关的因素。
我们于 2013 年使用基于网络的调查收集了荷兰和比利时注册整脊医师的社会人口学数据、实践特征、影像学使用量、意见和影像学指征。另外，通过 6 个腰痛病例描述评估对腰痛影像学指南的遵从情况。多变量回归分析用于探索医师特征与影像学使用之间的关联。广义混合模型用于探索对指南的遵从情况及其与医师特征的关系。
总应答率为 60%（340 名中的 203 名）。总体而言，83%的整脊医师认为诊断性影像学是其实践的重要组成部分。需要注意的是，荷兰和比利时的整脊医师不被允许直接开出影像学检查。整脊医师报告称他们希望对 42%的患者进行影像学检查。在首次就诊前，已有 37%的患者进行过影像学检查，且影像学检查是由其他医疗保健提供者（即全科医生或医学专家）开出的。最常见的影像学检查指征是排除禁忌症（73%）。最常见的不进行影像学检查的原因是认为影像学检查的价值有限（45%）。许多整脊医师（71%）熟悉影像学指南。根据病例描述，对腰痛患者的影像学指南的遵从率为 66%。与比利时整脊医师和从业 10 年以上的整脊医师相比，荷兰整脊医师和从业不足 10 年的整脊医师在对指南的遵从和影像学使用方面表现更好。
大多数荷兰和比利时整脊医师报告称影像学在整脊实践中很重要。大多数情况下，他们报告的影像学检查指征符合影像学指南。我们发现比利时和荷兰整脊医师之间以及从业年限与对指南的遵从之间存在一些差异。
