Intervention usage for the management of low back pain in a chiropractic teaching clinic

Abstract

Background Despite numerous low back pain (LBP) clinical practice guidelines, published studies suggest guideline nonconcordant care is still offered. However, there is limited literature evaluating the degree to which chiropractors, particularly students, follow clinical practice guidelines when managing LBP. The aim of this study was to evaluate the frequency of use of specific interventions for LBP by students at a chiropractic teaching clinic, mapping recommended, not recommend, and without recommendation interventions based on two clinical practice guidelines. Methods This was a retrospective chart review of patients presenting to the Canadian Memorial Chiropractic College teaching clinic with a new complaint of LBP from January to July 2019. Interventions provided under treatment plans for each patient were extracted. Interventions were classified as recommended, not recommended, or without recommendation according to two guidelines, the NICE and OPTIMa LBP guideline. Results 1000 patient files were identified with 377 files meeting the inclusion criteria. The most frequent interventions provided to patients were manipulation/mobilization (99%) and soft tissue therapy (91%). Exercise, localized percussion, and advice and/or education were included in just under half of the treatment plans. Patient files contained similar amounts of recommended (70%) and not recommended (80%) interventions according to the NICE guideline classification, with half the treatment plans including an intervention without recommendation. Under the OPTIMa acute guideline, patient files contained similar amounts of recommended and not recommended care, while more recommended care was provided than not recommended under the OPTIMa chronic guideline. Conclusions Despite chiropractic interns providing guideline concordant care for the majority of LBP patients, interventions classified as not recommended and without recommendation are still frequently offered. This study provides a starting point to understand the treatment interventions provided by chiropractic interns. Further research should be conducted to improve our understanding of the use of LBP guideline recommended care in the chiropractic profession. Trial registration Open Science Framework # g74e8.

Exploring usual care for patients with low back pain in primary care: a cross-sectional study of general practitioners, physiotherapists and chiropractors

“…Another study shows that Danish PTs often informed about the benign nature of LBP but were hesitant to advise on return to normal activity and work, while they provided advice on posture and ergonomics which is not recommended 26. This example, along with several others,16 27 illustrates the eclectic composition of recommended and non-recommended care across primary care.…”

“…A Canadian study of a chiropractic teaching clinic showed that most treatment plans for LBP patients included guideline-concordant care (eg, patient education, exercise and spinal manipulation/mobilisation) but also often non-recommended care like manual therapy as monotherapy. 16 This monodisciplinary example indicates that both recommended and non-recommended elements of care may be provided concomitantly. Still, it does not provide insights into the most frequent combinations of care offered to patients with LBP or whether the findings are generalisable to other primary healthcare provider groups that care for LBP patients.…”

“…Further, recommended elements of care may be combined with non-recommended elements. A Canadian study of a chiropractic teaching clinic showed that most treatment plans for LBP patients included guideline-concordant care (eg, patient education, exercise and spinal manipulation/mobilisation) but also often non-recommended care like manual therapy as mono-therapy 16. This monodisciplinary example indicates that both recommended and non-recommended elements of care may be provided concomitantly.…”

How Much Physiotherapy, Chiropractic, and Osteopathy Care Do Compensated Australian Workers with Low Back Pain Receive? A Retrospective Cohort Study

“…Differences in the likelihood of attending a given profession may have been driven by the availability of each type of profession. For example, in the last year of the * p < 0.01 1 Odds ratio (99% confidence interval) 2 Reference category 3 Cells suppressed 4 Cells perturbed at random to suppress small cell sizes 5 Regional and remote are combined in descriptive statistics due to small cell sizes study ( 2015), Victoria had 17.4 osteopaths per 100,000 residents, compared to 3.8 per 100,000 in Queensland, and 2.1 and 2.4 in South Australia and Western Australia, respectively [34]. The differences in rates of clinicians aligns with the results of this study.…”

“…Many health professionals including physiotherapists, chiropractors, and osteopaths can provide many of the recommended treatments for low back pain [3,4]. However, the more specific therapeutic choices and modes of delivery may vary by clinician training and profession-specific guidelines [5][6][7][8], and these may be supported by varying levels of evidence [7,9]. Workers' compensation schemes fund reasonable and necessary health care and rehabilitation services for individuals who are unable to work due to work-related conditions, including low back pain [10,11].…”