Diagnostic imaging does not lead to better clinical outcomes for patients who visit a chiropractor for their lower back pain, according to research published in Chiropractic & Manual Therapies.
Among more than 2,000 individuals, including nearly one-quarter referred for imaging, radiological examination did not result in improved pain levels. In fact, those who did undergo imaging had slightly more intense back pain during follow-up, but the changes were not clinically relevant, the authors noted.
Providers continue to order imaging for such pain despite international guidelines recommending against this practice. Similarly, many chiropractors believe these guidelines don’t apply to their profession and view X-ray exams, among other tests, as necessary for optimal care.
Hazel J. Jenkins, with Macquarie University’s Faculty of Medicine in Australia, and colleagues say their findings suggest otherwise.
“The results of this study support that recommendations from current clinical guidelines for the use of imaging for low back pain are equally relevant for patients presenting for chiropractic care as for those patients presenting to other health professionals,” the authors added.
Lower back pain is the most common reason patients seek out chiropractic care and X-ray imaging is the most utilized exam in these situations, ordered in 8%-84% of cases, the authors noted. But there have been no studies assessing imaging’s impact on clinical outcomes in the chiropractic setting.
So, Jenkins et al. analyzed 2,162 patients with lower back pain who visited a primary care chiropractic clinic in Denmark between November 2016 and December 2019. Of that group, 24.1% were referred for MRI, X-ray or CT.
Overall, there were no differences between both groups in terms of back pain intensity and disability at two weeks and back pain at one year.
Prior studies have also found that patients who undergo imaging are more satisfied with their care. Jenkins and colleagues administered a questionnaire for their study testing this hypothesis but found imaging exams did not significantly impact patients’ opinions.
“These results suggest that current guideline recommendations against routine imaging apply equally to chiropractic practice,” the authors concluded.
Read the full study here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.