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Low back pain in general medical and chiropractic practice:

Low back pain (LBP) patients often undergo diagnostic imaging, a procedure that is being increasingly used. Over the last 10 years the use of magnetic resonance imaging (MRI) has almost quadrupled, whereas the use of radiographs has decreased by more than 20% over the last 15 years. Although the scientific evidence for or against imaging for LBP is generally weak and lacking quality, many clinical guidelines have been developed over the years, trying to establish prudent indications. The Cochrane Institute has stated that prospective studies controlled for confounding are needed to further study the value of using diagnostic imaging on LBP patients.

We are conducting a prospective study of 1500 patients with persistent LBP, seen at 3–4 chiropractic clinics and at the Spine Center, Regional Hospital Silkeborg. Participating patients are given a full clinical examination and relevant information is gathered at baseline. The patients receive diagnostic imaging (MRI or radiographs).

The purpose of our study is to: 

1) perform a systematic review of the literature;

2) establish a standardized and reproducible format for reporting image findings;

3) through a cross-sectional study at baseline, we will study the association between image findings and clinical observations in chiropractic practice and at a spine center in a hospital setting; and,

4) complete a one-year observational cohort study on the same patient group to assess the prognostic value of image findings in LBP patients. Primary outcome measures are: low back pain, leg pain and disability. Secondary outcome measures are: contacts to the health care system, job situation, sick leave, use of pain relievers and patient satisfaction.

  • Klaus Knarberg Doktor, University of Southern Denmark
  • Jan Hartvigsen, University of Southern Denmark and Nordic Institute of Chiropractic and Clinical Biomechanics
  • Tue Secher Jensen, University of Southern Denmark Hospital and Nordic Institute of Chiropractic and Clinical Biomechanics
  • Henrik Wulff Christensen, Nordic Institute of Chiropractic and Clinical Biomechanics
  • Ulrich Fredberg, Diagnostic Center, Regional Hospital Silkeborg