The human spine consists of the vertebrae (the bones making up the spine), having cartilage discs between them. The discs have a circle of connective tissue with a main gel like core, that tends to make the spine flexible and at exactly the same time functions as a protective buffer.
In the Netherlands and Belgium, low-back pain (LBP) is common and costly. One of the professions treating LBP is chiropractic, a legalized and well-established profession within the healthcare system in many countries, such as Denmark, the USA, and Australia. As a result, chiropractors provide a significant proportion of the care for people with low back pain (LBP) in these countries. Despite the fact that chiropractic is a relatively small profession, the number of chiropractors in the Netherlands has increased from 150 to 299 over the past 20 years, and in Belgium from 97 to 130 chiropractors over the last 5 years. In the Netherlands, with its 17 million inhabitants, more than 1 million chiropractic treatments were delivered in 2019. The great majority of these consultations were for LBP, the same would apply for Belgium.
Many national and international clinical guidelines for the management of LBP have been developed. The chiropractic guidelines do not differ from the multidisciplinary guidelines. These clinical practice guidelines can support health care providers in deciding on the appropriate care for the patient. By adhering to clinical guidelines, management of LBP will be more effective and safe. In the Netherlands and Belgium, there are multidisciplinary guidelines for LBP. While the Netherlands Chiropractic Association (NCA) has developed guidelines for acute and chronic LBP, these have not yet been published, while these are currently lacking for the Union of Belgian Chiropractors (BVC). Two international monodisciplinary guidelines have been published for chiropractors for acute and chronic LBP: the Mercy guidelines and synthesis of Council on Chiropractic Guideline and Practice Parameters. These clinical guidelines advise clinicians on treatment modalities to be used and on what advice should be given to LBP patients. The three most frequently addressed in the guidelines are advice to: (1) return-to-work; (2) limit bed rest and (3) stay active.
Studies suggest that chiropractors employ a wide variety of techniques and have varying views on clinical practice. Only two studies have been conducted which investigated Dutch and Belgian chiropractors treatment approaches; however, these studies did not examine which treatment modalities were most commonly used. Several studies suggest that healthcare providers do not always treat or provide advice which is consistent with international guidelines; however, it is not clear how this may apply to chiropractors in the Netherlands or Belgium. For example, three studies suggest that characteristics of healthcare providers, such as familiarity with the guidelines, and beliefs and perceptions may be important factors that influence adherence to the guidelines. Understanding these characteristics may help to position the chiropractic profession in these countries, and improve the awareness and implementation of guidelines by chiropractors.
Therefore, the aims of this study are: (1) To determine how chiropractors in the Netherlands and Belgium manage their patients; (2) To estimate whether their management approach is in line with the recommendations of clinical practice guidelines concerning return-to-work, limit bed rest, and stay active; and (3) To evaluate which factors are associated with the recommendations of the international chiropractic and multidisciplinary guidelines.