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Chiropractic Research Review

Is Radiography for Acute LBP Overutilized?

In Ontario, Canada, one-third of all patients with low back pain (LBP) go to a chiropractor; in nearly half of these cases, symptoms last less than six weeks, while only 20% last longer than six months.

The cost associated with a problem of this magnitude is immense, and the use of radiography is an important factor in this cost. Studies have shown that many DCs may use radiography in assessing acute LBP cases, despite evidence suggesting many of these patients do not require this evaluation.

Twenty-six chiropractors in an Ontario community were mailed questionnaires on personal and practice information; LBP management; and radiography use, including case scenarios in which DCs indicated whether or not radiography should be used. A focus group of seven chiropractors met later to discuss radiography use.

Based on the 76% response rate, 63% of the chiropractors said they would take radiographs of patients with uncomplicated acute LBP lasting less than one week; 68% of these DCs stated that radiography was helpful to evaluate patients with acute LBP lasting less than one month. The authors report that several reasons for using radiography on these patients are not supported by clinical evidence, however.

According to the authors, over 90% of acute LBP patients spontaneously improve within 4-6 weeks. Additionally, radiography is sometimes associated with poorer treatment outcomes. The authors write that "radiographs should only be considered in the presence of specific red flags, some of which include persistent limitations beyond 4 weeks, significant trauma, history of cancer, predisposition to fracture or infection, unexplained weight loss, pain that worsens with rest, or high fever."

Ammendolia C, Bombardier C, et al. Views on radiography use for patients with acute low back pain among chiropractors in an Ontario community. Journal of Manipulative and Physiological Therapeutics 2002:25(8), pp. 511-520. www.mosby.com/jmpt

Chiropractic Research Review

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