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J Manipulative Physiol Ther. 2011 May;34(4):204-10. doi: 10.1016/j.jmpt.2011.04.005. Epub 2011 May 4.

Development of disease-specific quality indicators for Danish chiropractic patients with low back pain.

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  • 1The Danish National Indicator Project, Aarhus, Denmark.



The purpose of this study is to develop disease-specific quality indicators for Danish chiropractic patients with low back pain (LBP) as an initial effort to include chiropractors in the Danish Health Care Quality Programme.


A cross-disciplinary Indicator Group consisting of researchers and clinicians prioritized 9 evidence-based quality indicators and quality performance standards in a systematic consensus process. A feasibility study involving 20 chiropractors in 8 chiropractic clinics and 206 LBP patients was undertaken. Afterward, an audit meeting was held where participating clinicians could voice their opinion and share experiences. After the test and audit, the Indicator Group reconvened and decided on the final set of indicators.


The following quality indicators were chosen: case history, test for discogenic back pain, neurology, radiology, classification, exercise therapy, outcome assessment, and reevaluation. Only the outcome assessment indicators met the standards set by the Indicator Group. Based on the feedback supplied at the audit meeting and after evaluating the test results, the Indicator Group decided to reduce the standards but keep all indicators.


This study showed that it is possible to describe quality indicators for the assessment and treatment of LBP patients, to identify the patient population, and to collect data. The participating clinics did not meet the original quality standards set by the Indicator Group. Reasons for this may include unrealistically high thresholds set by the Indicator Group and the somewhat complex or compound structure of some of the indicators. The Indicator Group and the test clinics recommend future nationwide implementation of the developed quality indicators.

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