1
|
Arnone PA, Kraus SJ, Farmen D, Lightstone DF, Jaeger J, Theodossis C. Examining Clinical Opinion and Experience Regarding Utilization of Plain Radiography of the Spine: Evidence from Surveying the Chiropractic Profession. J Clin Med 2023; 12:jcm12062169. [PMID: 36983168 PMCID: PMC10054546 DOI: 10.3390/jcm12062169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
Plain Radiography of the spine (PROTS) is utilized in many forms of healthcare including the chiropractic profession; however, the literature reflects conflicting opinions regarding utilization and value. Despite being an essential part of Evidence-Based Practice (EBP), few studies assess Doctors of Chiropractic (DCs) clinical opinions and experience regarding the utilization of (PROTS) in practice. In this study, DCs were surveyed regarding utilization of PROTS in practice. The survey was administered to an estimated 50,000 licensed DCs by email. A total of 4301 surveys were completed, of which 3641 were United States (US) DCs. The Clinician Opinion and Experience on Chiropractic Radiography (COECR) scale was designed to analyze survey responses. This valid and reliable scale demonstrated good internal consistency using confirmatory factor analysis and the Rasch model. Survey responses show that 73.3% of respondents utilize PROTS in practice and 26.7% refer patients out for PROTS. Survey responses show that, among US DCs, 91.9% indicate PROTS has value beyond identification of pathology, 86.7% indicate that PROTS is important regarding biomechanical analysis of the spine, 82.9% indicate that PROTS is vital to practice, 67.4% indicate that PROTS aids in measuring outcomes, 98.6% indicate the opinion that PROTS presents very low to no risk to patients, and 93.0% indicate that sharing clinical findings from PROTS studies with patients is beneficial to clinical outcomes. The results of the study indicated that based on clinical experience, the majority of DCs find PROTS to be vital to practice and valuable beyond the identification of red flags.
Collapse
Affiliation(s)
- Philip A. Arnone
- The Balanced Body Center, Matthews, NC 28105, USA
- Correspondence:
| | | | - Derek Farmen
- The Balanced Body Center, Matthews, NC 28105, USA
| | | | - Jason Jaeger
- Community Based Internship Program, Associate Faculty, Southern California University of Health Sciences, Whittier, CA 90604, USA
| | - Christine Theodossis
- Chair, Radiology Department, Sherman College of Chiropractic, Boiling Springs, SC 29316, USA
| |
Collapse
|
2
|
Shiba H, Kenzaka T. Straight Back Syndrome Presented with Chest and Back Pain: A Case Report. Int Med Case Rep J 2022; 15:611-614. [PMCID: PMC9635548 DOI: 10.2147/imcrj.s385312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022] Open
Abstract
A 17-year-old female adolescent presented with her mother to our clinic with a two-month history of left-sided chest pain and a one-week history of middle back pain. We diagnosed straight back syndrome based on the chest and thoracic radiographic findings and symptoms of chest pain, palpitations, and dyspnea. We reassured the patient that the disease was benign and advised her to start and continue chiropractic therapy. All symptoms, including back pain, disappeared in three weeks. Straight back syndrome is under-diagnosed, and back pain is less recognized as a symptom of the disease.
Collapse
Affiliation(s)
- Hiroshi Shiba
- Department of Internal Medicine, Suwa Central Hospital, Chino, Japan,Correspondence: Hiroshi Shiba, Department of Internal Medicine, Suwa Central Hospital, 4300 Tamagawa, Chino, Nagano-ken, 391-8503, Japan, Tel +81-0266-72-1000, Fax +81-0266-72-4120, Email
| | - Tsuneaki Kenzaka
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan,Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
3
|
Liu Y, Wang W, Long W, Cai B, Chen C, Wang W, Guan S, Luo J, Chen K. Chest wall reconstruction with digitally designed materials for straight back syndrome with tracheal stenosis: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1357. [PMID: 34532494 PMCID: PMC8422149 DOI: 10.21037/atm-21-3976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/20/2021] [Indexed: 11/06/2022]
Abstract
Severe symptoms of straight back syndrome (SBS) occur through compression of the mediastinal structures. The treatment is to relieve compression, but surgical relief has not been reported. A 29-year-old woman was admitted to hospital because of dyspnea for 2 years. Physical examination showed the physiological curvature of the spine had disappeared and imaging examination confirmed that the spine was straight, the distance between the spine and the anterior chest wall was shortened, and the lower part of the trachea was obviously compressed with a severe stenosis. The chest wall was simulated by 3D technology, and a model was obtained by 3D printing. The surgical resection was simulated on the model, and the required replacement material was digitally designed and processed. The upper half of the sternum, the first and second costal cartilages, and the thymus were excised. After the chest wall defect was repaired with the digital material, the ascending aorta was suspended on the reconstruction to relieve the tracheal compression. The operation was completed in 135 min without any complications. All symptoms disappeared after operation. Postoperative imaging examination showed complete resolution of the tracheal stenosis. The patient was discharged 10 days after operation. Surgical reconstruction of the anterior chest wall is a good method for treating tracheal stenosis in SBS, and digitally produced material is ideal for the reconstruction.
Collapse
Affiliation(s)
- Yang Liu
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Wenlin Wang
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Weiguang Long
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Bin Cai
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Chunmei Chen
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Wenjie Wang
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Shubin Guan
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Juan Luo
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| | - Kai Chen
- Department of Chest Wall Surgery, Guangdong Second Provincial People's Hospital, Guangzhou, China
| |
Collapse
|
4
|
Oakley PA, Betz JW, Harrison DE, Siskin LA, Hirsh DW. Radiophobia Overreaction: College of Chiropractors of British Columbia Revoke Full X-Ray Rights Based on Flawed Study and Radiation Fear-Mongering. Dose Response 2021; 19:15593258211033142. [PMID: 34421439 PMCID: PMC8375354 DOI: 10.1177/15593258211033142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 01/11/2023] Open
Abstract
Fears over radiation have created irrational pressures to dissuade radiography use within chiropractic. Recently, the regulatory body for chiropractors practicing in British Columbia, Canada, the College of Chiropractors of British Columbia (CCBC), contracted Pierre Côté to review the clinical use of X-rays within the chiropractic profession. A "rapid review" was performed and published quickly and included only 9 papers, the most recent dating from 2005; they concluded, "Given the inherent risks of radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine." The CCBC then launched an immediate review of the use of X-rays by chiropractors in their jurisdiction. Member and public opinion were gathered but not presented to their members. On February 4, 2021, the College announced amendments to their Professional Conduct Handbook that revoked X-ray rights for routine/repeat assessment and management of patients with spine disorders. Here, we highlight current and historical evidence that substantiates that X-rays are not a public health threat. We also point out critical and insurmountable flaws in the single paper used to support irrational and unscientific policy that discriminates against chiropractors who practice certain forms of evidence-based X-ray-guided methods.
Collapse
Affiliation(s)
| | | | | | | | | | - International Chiropractors Association Rapid Response Research Review Subcommittee
- Private Practice, Newmarket, ON, Canada
- Private Practice, Boise, ID, USA
- CBP NonProfit, Inc, Eagle, ID, USA
- Private Practice, Green Brook, NJ, USA
- Private Practice, Laurel, MD, USA
| |
Collapse
|
5
|
Oakley PA, Harrison DE. Radiophobic Fear-Mongering, Misappropriation of Medical References and Dismissing Relevant Data Forms the False Stance for Advocating Against the Use of Routine and Repeat Radiography in Chiropractic and Manual Therapy. Dose Response 2021; 19:1559325820984626. [PMID: 33628151 PMCID: PMC7883173 DOI: 10.1177/1559325820984626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/14/2022] Open
Abstract
There is a faction within the chiropractic profession passionately advocating against the routine use of X-rays in the diagnosis, treatment and management of patients with spinal disorders (aka subluxation). These activists reiterate common false statements such as "there is no evidence" for biomechanical spine assessment by X-ray, "there are no guidelines" supporting routine imaging, and also promulgate the reiterating narrative that "X-rays are dangerous." These arguments come in the form of recycled allopathic "red flag only" medical guidelines for spine care, opinion pieces and consensus statements. Herein, we review these common arguments and present compelling data refuting such claims. It quickly becomes evident that these statements are false. They are based on cherry-picked medical references and, most importantly, expansive evidence against this narrative continues to be ignored. Factually, there is considerable evidential support for routine use of radiological imaging in chiropractic and manual therapies for 3 main purposes: 1. To assess spinopelvic biomechanical parameters; 2. To screen for relative and absolute contraindications; 3. To reassess a patient's progress from some forms of spine altering treatments. Finally, and most importantly, we summarize why the long-held notion of carcinogenicity from X-rays is not a valid argument.
Collapse
|
6
|
Oakley PA, Harrison DE. Are Restrictive Medical Radiation Imaging Campaigns Misguided? It Seems So: A Case Example of the American Chiropractic Association's Adoption of "Choosing Wisely". Dose Response 2020; 18:1559325820919321. [PMID: 32425722 PMCID: PMC7218311 DOI: 10.1177/1559325820919321] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 12/18/2022] Open
Abstract
Since the 1980s, increased utilization of medical radiology, primarily computed tomography, has doubled medically sourced radiation exposures. Ensuing fear-mongering media headlines of iatrogenic cancers from these essential medical diagnostic tools has led the public and medical professionals alike to display escalating radiophobia. Problematically, several campaigns including Image Gently, Image Wisely, and facets of Choosing Wisely propagate fears of all medical radiation, which is necessary for the delivery of effective and efficient health care. Since there are no sound data supporting the alleged risks from low-dose radiation and since there is abundant evidence of health benefits from low-doses, these imaging campaigns seem misguided. Further, thresholds for cancer are 100 to 1000-fold greater than X-rays, which are within the realm of natural background radiation where no harm has ever been validated. Here, we focus on radiographic imaging for use in spinal rehabilitation by manual therapists, chiropractors, and physiotherapists as spinal X-rays represent the lowest levels of radiation imaging and are critical in the diagnosis and management of spine-related disorders. Using a case example of a chiropractic association adopting "Choosing Wisely," we argue that these campaigns only fuel the pervasive radiophobia and continue to constrain medical professionals, attempting to deliver quality care to patients.
Collapse
|
7
|
Oakley PA, Harrison DE. Radiophobia: 7 Reasons Why Radiography Used in Spine and Posture Rehabilitation Should Not Be Feared or Avoided. Dose Response 2018; 16:1559325818781445. [PMID: 30013456 PMCID: PMC6043928 DOI: 10.1177/1559325818781445] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/04/2018] [Accepted: 05/15/2018] [Indexed: 12/21/2022] Open
Abstract
Evidence-based contemporary spinal rehabilitation often requires radiography. Use of radiography (X-rays or computed tomography scans) should not be feared, avoided, or have their exposures lessened to decrease patient dose possibly jeopardizing image quality. This is because all fears of radiation exposures from medical diagnostic imaging are based on complete fabrication of health risks based on an outdated, invalid linear model that has simply been propagated for decades. We present 7 main arguments for continued use of radiography for routine use in spinal rehabilitation: (1) the linear no-threshold model for radiation risk estimates is invalid for low-dose exposures; (2) low-dose radiation enhances health via the body's adaptive response mechanisms (ie, radiation hormesis); (3) an X-ray with low-dose radiation only induces 1 one-millionth the amount of cellular damage as compared to breathing air for a day; (4) radiography is below inescapable natural annual background radiation levels; (5) radiophobia stems from unwarranted fears and false beliefs; (6) radiography use leads to better patient outcomes; (7) the risk to benefit ratio is always beneficial for routine radiography. Radiography is a safe imaging method for routine use in patient assessment, screening, diagnosis, and biomechanical analysis and for monitoring treatment progress in daily clinical practice.
Collapse
|