Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
Chiropr Man Therap. 2024 Jun 22;32(1):23. doi: 10.1186/s12998-024-00547-y.
Radiography is commonly used in the assessment of spinal disorders, despite a lack of high-quality evidence demonstrating improved clinical outcomes or additional benefit to the patient. There is disagreement amongst chiropractors regarding the appropriate use of radiography for clinical management. This study aims to qualitatively explore chiropractors' perceptions on the use of spinal radiographs in clinical practice with respect to how they determine when to order radiographs; and how they use radiographs to inform clinical management.
Online qualitative semi-structured interviews were conducted with 17 Australian chiropractors who currently manage patients with spinal disorders. Convienence, snowball, and purposive sampling strategies were used to ensure an appropriate breadth and depth of participant characterisitcs and beliefs. Interview data were recorded, transcribed and analysed using framework analysis.
Three themes were developed to describe how chiropractors determined when to order radiographs. These themes included specific findings from the clinical encounter that may inform clinical management, their perceptions of radiation risk, and the influence of clinical experience/intuition. Three themes and four subthemes were developed for how chiropractors use radiographs to inform their management. These themes explored the use of radiography for the application of chiropractic technique, as well as the role of radiographs in predicting patient prognosis, and as an educational tool to provide reassurance.
Australian chiropractors' decision-making around spinal radiography is diverse and can be influenced by a number of clinical and external factors. Previously unexplored uses of spinal radiography in clinical practice were highlighted. Some chiropractors reported potential benefits of radiography that are currently not supported by research evidence. Future research should address how radiographic findings are reported to patients with spinal disorders and how this could be optimised to improve patient outcomes.
尽管缺乏高质量的证据表明放射摄影术能改善临床结果或对患者有额外益处，但放射摄影术仍常用于评估脊柱疾病。对于放射摄影术在临床管理中的适当应用，脊医之间存在分歧。本研究旨在定性探讨脊医对放射摄影术在临床实践中的使用的看法，具体涉及他们如何确定何时进行放射摄影；以及他们如何使用放射摄影术来为临床管理提供信息。
对 17 名目前管理脊柱疾病患者的澳大利亚脊医进行了在线定性半结构式访谈。采用便利、滚雪球和目的抽样策略，以确保参与者的特征和信念具有适当的广度和深度。使用框架分析对访谈数据进行记录、转录和分析。
确定了三个主题来描述脊医何时决定进行放射摄影。这些主题包括从临床遇到的具体发现中可能为临床管理提供信息、他们对辐射风险的看法以及临床经验/直觉的影响。为了描述脊医如何使用放射摄影术来为其管理提供信息，开发了三个主题和四个子主题。这些主题探讨了放射摄影术在应用脊骨手法中的作用，以及放射摄影术在预测患者预后以及作为提供保证的教育工具方面的作用。
澳大利亚脊医在放射摄影术方面的决策是多种多样的，可能受到许多临床和外部因素的影响。本研究还强调了一些以前未被探索过的放射摄影术在临床实践中的应用。一些脊医报告了放射摄影术的潜在益处，但目前这些益处没有得到研究证据的支持。未来的研究应解决如何向患有脊柱疾病的患者报告放射学发现以及如何优化报告以改善患者结果的问题。
