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  • 047 Identifying Factors Predictive of Managing Patients with Low Back Pain without Using X-Rays Among North American Chiropractors: Applying Psychological Theories to Evidence-Based Clinical Practice

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047 Identifying Factors Predictive of Managing Patients with Low Back Pain without Using X-Rays Among North American Chiropractors: Applying Psychological Theories to Evidence-Based Clinical Practice
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  1. A Bussières1,2,
  2. J Francis3,
  3. A Patey3,
  4. M Gagnon4,
  5. A Sales5,
  6. M Eccles6,
  7. L Lemyre7,
  8. G Godin4,
  9. J Grimshaw8
  1. 1School Physical Occupational Therapy, Faculty of Medicine/McGill University, Montreal, Canada
  2. 2Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
  3. 3Health Services Research and Management, City University London, London, UK
  4. 4Faculté des sciences infirmières,Université Laval, Québec, Canada
  5. 5School of Nursing,University of Michigan, Michigan, USA
  6. 6Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle, UK
  7. 7School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
  8. 8Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada

Abstract

Background This study aimed to identify theoretically based modifiable factors that predict whether chiropractors manage patients with low back pain without ordering lumbar x-rays.

Methods A mailed survey with psychological measures was collected from a random sample of Ontario (Canada) and Practice Network (US) chiropractors. The outcome measures were behavioural intention and behavioural simulation (scenario decision-making). Explanatory variables included constructs from motivational theories (Theory of Planned Behaviour (TPB), Theory of Interpersonal Behaviour (TIB)), action theories (Operant Learning Theory (OLT) and Planning (action and coping)), and two other constructs: personal moral norm and habit as measured by the Self-Reported Habit Index (SRHI). Multiple regression analyses examined the predictive value of each theoretical model individually for simulation and intention outcomes.

Results 31% of North American chiropractors returned completed questionnaires. Overall, TPB and TIB, followed by personal moral norms and OLT best explained behavioural simulation. Theory level variance explained among Ontario and US chiropractors was respectively: TPB 59%; 52.0%, TIB 57%; 54.0%, personal moral norm 49%; 46.0%, OLT 49%; 52.0%, action planning 28%; 29%, and SRHI 42%; 48%. Constructs from TPB and TIB best explained behavioural intention. Theory level variance explained was respectively: TPB 85%; 74%, TIB; 83%; 81%, OLT 62%; 69%, and SRHI 59% and 52% for SRHI.

Conclusion These models explained up to 59% of the variation in behavioural simulation and up to 85% in intention to manage back pain patients without x-rays. Results may inform development of theory-based behaviour change interventions to implement imaging guideline recommendations among North American chiropractors. These models explained up to 59% of the variation in behavioural simulation and up to 85% in intention to manage back pain patients without x-rays. Results may inform development of theory-based behaviour change interventions to implement imaging guideline recommendations among North American chiropractors.

https://doi.org/10.1136/bmjqs-2013-002293.78

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