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Eur Spine J. 2018 Jul;27(7):1517-1525. doi: 10.1007/s00586-017-5295-0. Epub 2017 Sep 18.

Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study.

Author information

1
Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. cesar.hincapie@utoronto.ca.
2
Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. cesar.hincapie@utoronto.ca.
3
Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Canada. cesar.hincapie@utoronto.ca.
4
Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
5
Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.
6
UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada.
7
Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Canada.
8
Institute for Global Health Equity and Innovation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
9
Centre for Global eHealth Innovation, University Health Network, Toronto, Canada.
10
Department of Medicine, Toronto General Research Institute, University Health Network, Toronto, Canada.

Abstract

PURPOSE:

Chiropractic spinal manipulation treatment (SMT) is common for back pain and has been reported to increase the risk for lumbar disc herniation (LDH), but there is no high quality evidence about this. In the absence of good evidence, clinicians can have knowledge and beliefs about the risk. Our purpose was to determine clinicians' beliefs regarding the risk for acute LDH associated with chiropractic SMT.

METHODS:

Using a belief elicitation design, 47 clinicians (16 chiropractors, 15 family physicians and 16 spine surgeons) that treat patients with back pain from primary and tertiary care practices were interviewed. Participants' elicited incidence estimates of acute LDH among a hypothetical group of patients with acute low back pain treated with and without chiropractic SMT, were used to derive the probability distribution for the relative risk (RR) for acute LDH associated with chiropractic SMT.

RESULTS:

Chiropractors expressed the most optimistic belief (median RR 0.56; IQR 0.39-1.03); family physicians expressed a neutral belief (median RR 0.97; IQR 0.64-1.21); and spine surgeons expressed a slightly more pessimistic belief (median RR 1.07; IQR 0.95-1.29). Clinicians with the most optimistic views believed that chiropractic SMT reduces the incidence of acute LDH by about 60% (median RR 0.42; IQR 0.29-0.53). Those with the most pessimistic views believed that chiropractic SMT increases the incidence of acute LDH by about 30% (median RR 1.29; IQR 1.11-1.59).

CONCLUSIONS:

Clinicians' beliefs about the risk for acute LDH associated with chiropractic SMT varied systematically across professions, in spite of a lack of scientific evidence to inform these beliefs. These probability distributions can serve as prior probabilities in future Bayesian analyses of this relationship.

KEYWORDS:

Bayesian approach; Belief elicitation; Chiropractic; Intervertebral disc displacement; Risk; Spinal manipulation

PMID:
28924697
DOI:
10.1007/s00586-017-5295-0
[Indexed for MEDLINE]

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