American Chiropractic Association’s Participation in Choosing Wisely: Close Inspection Shows No Evidence to Support its Anti-Imaging Points 1 and 2.
American Chiropractic Association’s Participation in Choosing Wisely: Close Inspection Shows No Evidence to Support its Anti-Imaging Points 1 and 2.
Authors
- Paul A. Oakley
- Deed E. Harrison
Publication
Asia-Pacific Chiropractic Journal 2020;1.2: online only.
Article Link
Abstract
Recently, the American Chiropractic Association (ACA) joined the Choosing Wisely initiative which encourages participating societies to identify 5-10 tests, treatments or procedures that are perceived as commonly overutilized within their healthcare discipline. The goal is to educate patients and doctors of specific practices to
question and limit their use. The ACA created their list of five strategies by an internal committee that was then approved by the ACA board of governors. The first two strategies include avoiding X-rays: Point 1 is to not X-ray a patient presenting with acute low back pain within 6-weeks of onset; Point 2 is to not perform repeat imaging to monitor patients’ progress. It has recently been illustrated how this initiative has backfired causing insurance companies to use the ACA’s list as profession guidelines per se, to limit financial reimbursements to chiropractors. It has also been pointed out that these two points are not evidence-based, the chiropractic and spine rehabilitation literature is profuse with high-quality and evolving evidence supporting how radiography is intimately connected to procedural approaches and patient outcomes. Herein we assess the validity of the ACA’s Choosing Wisely Points 1 and 2 by inspecting the supporting references and statements. It is concluded that the supporting citations do not support the endorsement of the ACA’s two points to refrain from X-ray use. Further the supporting statements are fraught with arguments from the medical perspective; that is, the practice of general medicine. Many factions within chiropractic utilize X-rays beyond ‘red flag’ screening and much more substantially than MDs, and these practice approaches are evidence-based, ethical and patient-centered. We recommend the ACA retracts Points 1
and 2 condemning radiography use as it is antithetical to scientific reality and to the practice of contemporary chiropractic approaches.