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Management of people with acute low-back pain: a survey of Australian chiropractors Full Text
Chiropractic & Osteopathy , 02/03/2012
Walker BF et al. – The intention of chiropractors surveyed in this study shows low adherence to two recommendations from an evidence–based guideline for acute LBP. Quality of care for these patients could be improved through effective implementation of evidence–based guidelines. Further research to find cost–effective methods to increase implementation is warranted.
Methods- This is a cross sectional survey of chiropractors in Australia.
- This paper is part of the ALIGN study in which a targeted implementation strategy was developed to improve the management of acute LBP in a chiropractic setting.
- This implementation strategy was subsequently tested in a cluster randomised controlled trial.
- In this survey phase of the ALIGN study authors approached a random sample of 880 chiropractors in three States of Australia.
- The mailed questionnaire consisted of five patient vignettes designed to represent people who would typically present to chiropractors with acute LBP.
- Four vignettes represented people who, according to the guideline, would not require a plain lumbar x–ray, and one vignette represented a person with a suspected vertebral fracture.
- Respondents were asked, for each vignette, to indicate which investigation(s) they would order, and which intervention(s) they would recommend or undertake.
- Of the 880 chiropractors approached, 137 were deemed ineligible to participate, mostly because they were not currently practising, or mail was returned to sender.
- Authors received completed questionnaires from 274 chiropractors (response rate of 37%).
- Male chiropractors made up 66% of respondents, 75% practised in an urban location and their mean number of years in practice was 15.
- Across the four vignettes where an x–ray was not indicated 68% (95% Confidence Intervals (CI): 64%, 71%) of chiropractors responded that they would order or take an x–ray.
- In addition 51% (95%CI: 47%, 56%) indicated they would give advice to stay active when it was indicated.
- For the vignette where a fracture was suspected, 95% (95% CI: 91%, 97%) of chiropractors would order an x–ray.