Abstract
BackgroundDespite 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.MethodsThis 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.Results1000 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.ConclusionsDespite 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 registrationOpen Science Framework # g74e8.
Highlights
Despite numerous low back pain (LBP) clinical practice guidelines, published studies suggest guideline nonconcordant care is still offered
A recent study published after this systematic review found that 95% of patients with LBP seeking care in United Kingdom private physiotherapy clinics received a recommended treatment, whereas 32% of patients received a treatment with recommendations against and 34% received a treatment without a recommendation [14]
The difference in results according to each guideline is notable, with the most substantial difference being that the National Institute for Health and Care Excellence (NICE) guideline does not recommend using manual therapy as a stand-alone treatment
Summary
Despite numerous low back pain (LBP) clinical practice guidelines, published studies suggest guideline nonconcordant care is still offered. There is limited literature evaluating the degree to which chiropractors, students, follow clinical practice guidelines when managing LBP. Despite increased spending in the management of low back pain (LBP) in the past decade, global levels of disability related to LBP have not improved [1]. This may Csiernik et al Chiropractic & Manual Therapies (2022) 30:3 wide variety of interventions are utilized by chiropractors when managing LBP [4, 6], leading to inconsistencies within professional practice. A recent study published after this systematic review found that 95% of patients with LBP seeking care in United Kingdom private physiotherapy clinics received a recommended treatment, whereas 32% of patients received a treatment with recommendations against and 34% received a treatment without a recommendation [14]
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