J Manipulative Physiol Ther. 2002 Oct; 25(8): 511-20.

Views on radiography use for patients with acute low back pain among chiropractors in an Ontario community.

Ammendolia C, Bombardier C, Hogg-Johnson S, Glazier R.

Canadian Memorial Chiropractic College, Toronto, Ontario, Canada. ammendol@sympatico.ca

BACKGROUND: Recent studies suggest that chiropractors continue to widely use radiography for assessing patients with acute low back pain. This practice is contrary to growing evidence that suggests only a small percentage of patients with acute low back pain require radiographic evaluation. OBJECTIVES: To assess quantitatively and qualitatively the views of chiropractors in a selected community in Ontario on the use of radiography for evaluating patients with acute low back pain. Study Design: Mailed surveys and focus group interview. METHOD: Surveys were mailed to all chiropractors (N = 26) in a selected community in Ontario, followed by a focus group session with local chiropractors (n = 7). Surveys requested information on personal and practice characteristics and the management of low back pain, including the use of radiography. The focus group, led by a facilitator, discussed issues surrounding practice guidelines and radiography use. RESULTS: There was a 76% response rate to the mailed surveys. Of those who responded, 63% stated they would use radiography on patients with uncomplicated acute low back pain lasting 1 week; 68% stated that radiographs were useful in the diagnostic evaluation of patients with acute low back pain lasting less than 1 month. Most reasons given for use of radiography in this patient population are not supported by existing evidence. CONCLUSIONS: There appears to be a high rate of radiographic use by chiropractors in the study community, which is consistent with findings in previous studies. Many of the reasons given for use of radiography are not supported by existing evidence and may contribute to the gap between current chiropractic practice and available evidence with respect to use of radiography for acute low back pain.