Does Every Patient Require Imaging after Cervical Spine Trauma? A Knowledge Translation Project to Support Evidence-Informed Practice for Physiotherapists.

Abstract

Purpose: This article evaluates, describes, and addresses a gap in British Columbia physiotherapists' knowledge of the decision making required for the diagnostic imaging of patients after traumatic neck injury. Method: An online survey of orthopaedic physiotherapists in British Columbia was undertaken to explore their awareness of, knowledge of, and attitudes toward the Canadian Cervical Spine Rule (C-Spine Rule) and decision making regarding the need for diagnostic imaging in managing patients with traumatic neck injury. The survey included questions about managing clinical scenarios; respondents' awareness, knowledge, and use of a specific clinical decision rule-the C-Spine Rule-and any perceived barriers to using clinical practice guidelines in general and the C-Spine Rule in specific. The survey also included questions about the facilitators of and barriers to using the C-Spine Rule. These data were used to guide development of a tool kit to facilitate use of the rule. Results: Of 889 physiotherapists, 467 (52.5%) completed the survey. Given a scenario in which imaging was indicated according to the C-Spine Rule, 95.2% of the respondents correctly recommended imaging. However, in a scenario in which imaging was not indicated, 42.7% incorrectly recommended it. The barriers to using the guidelines included their perceived rigidity, role limitation, and reliance on clinical judgment. The results indicated a need for, and guided development of, resources to facilitate the use of the C-Spine Rule by British Columbia physiotherapists. Conclusions: We identified a gap in the knowledge of British Columbia physiotherapists in identifying which patients were most likely to require imaging after sustaining a traumatic neck injury. We developed a tool kit to address these barriers. British Columbia physiotherapists have accessed this resource extensively. Evaluating its impact on clinical practice, although desirable, was not feasible.