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Chiropractic & Manual Therapies
Published in: Chiropractic & Manual Therapies 1/2020

Open Access 01-12-2020 | Systematic review

The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature

Authors: Melissa Corso, Carol Cancelliere, Silvano Mior, Varsha Kumar, Ali Smith, Pierre Côté

Published in: Chiropractic & Manual Therapies | Issue 1/2020

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Abstract

Introduction

When indicated by signs or symptoms of potentially serious underlying pathology (red flags), chiropractors can use radiographs to inform their diagnosis. In the absence of red flags, the clinical utility of routine or repeat radiographs to assess the structure and function of the spine is controversial.

Objectives

To determine the diagnostic and therapeutic utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. Investigate whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. The research objectives required that we determine the validity, diagnostic accuracy and reliability of radiographs for the structural and functional evaluation of the spine.

Evidence review

We searched MEDLINE, CINAHL, and Index to Chiropractic Literature from inception to November 25, 2019. We used rapid review methodology recommended by the World Health Organization. Eligible studies (cross-sectional, case-control, cohort, randomized controlled trials, diagnostic and reliability) were critically appraised. Studies of acceptable quality were included in our synthesis. The lead author extracted data and a second reviewer independently validated the data extraction. We conducted a qualitative synthesis of the evidence.

Findings

We identified 959 citations, screened 176 full text articles and critically appraised 23. No relevant studies assessed the clinical utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. No studies investigated whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. Nine low risk of bias studies investigated the validity (n = 2) and reliability (n = 8) of routine or repeat radiographs. These studies provide no evidence of clinical utility.

Conclusion

We found no evidence that the use of routine or repeat radiographs to assess the function or structure of the spine, in the absence of red flags, improves clinical outcomes and benefits patients. Given the inherent risks of ionizing radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine.
Appendix
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Metadata
Title
The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature
Authors
Melissa Corso
Carol Cancelliere
Silvano Mior
Varsha Kumar
Ali Smith
Pierre Côté
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Chiropractic & Manual Therapies / Issue 1/2020
Electronic ISSN: 2045-709X
DOI
https://doi.org/10.1186/s12998-020-00323-8

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