Diagnostic and management concordance between chiropractors and neurosurgeons for patients with low back pain

Low back pain is the leading contributor to disability worldwide and a major cause of primary care visits. Alternative models of care delivery drawing on musculoskeletal experts' skills and knowledge have received increasing attention for their potential ability to improve timely access to appropriate healthcare for patients with musculoskeletal disorders. The aim of this study was to evaluate diagnostic and management concordance between chiropractors, known as musculoskeletal experts, and neurosurgeons for patients with low back pain. Before being seen by a neurosurgeon, 101 eligible participants (mean age: 60.32 years) were evaluated by a chiropractor. Overall diagnostic agreement between chiropractors and neurosurgeons was 74.7%, with a moderate inter-rater diagnosis agreement (κ = 0.51; 95%CI [0.35-0.68]). Chiropractors were significantly less likely to attribute a diagnosis of non-specific LBP to participants (31.6%) compared to neurosurgeons (43.2%) (p = 0.02), with an agreement proportion of 80.0%. Overall management agreement was 82.0%, indicating that chiropractors possess good skills in triaging patients with low back pain, which can optimize patient trajectories by accelerating management of non-surgical cases and reducing waiting lists for spine surgery consultations. Prospective studies are needed to evaluate the impact of a chiropractor-informed triage on clinical outcomes and healthcare utilization for patients with low back pain.