ACA & Choosing Wisely: Five Things Clinicians and Patients Should Question

ACA is proud to participate in the Choosing Wisely® campaign, led by the ABIM Foundation. The program provides evidence-based recommendations that support doctors and patients in making choices about their care.

The recommendations are designed to spark conversations between patients and their clinicians about the best, most appropriate care. The recommendations are not intended to prohibit any particular treatment in all scenarios or to dictate care decisions. They are also not intended to establish coverage decisions or exclusions. Rather, they should be viewed as opportunities to educate patients about health care procedures that are common, but whose usefulness in some cases is not supported by evidence.

ACA’s Choosing Wisely® recommendations were developed by the association’s Committee on Quality Assurance and Accountability and approved by the ACA Board of Governors after an extensive search of the most current scientific evidence on management and treatment options and months of careful review and consideration.


Patient Recommendations

Full text and references are available in the pdf linked above.

  1. Avoid routine spinal imaging in the absence of clear clinical indicators for patients with acute low back pain of less than six (6) weeks duration.
  2. Do not perform repeat imaging to monitor patients’ progress.
  3. Avoid protracted use of passive or palliative physical therapeutic modalities for low-back pain disorders unless they support the goal(s) of an active treatment plan.
  4. Do not provide long-term pain management without a psychosocial screening or assessment.
  5. Do not prescribe lumbar supports or braces for the long-term treatment or prevention of low-back pain.

Additional Resources

“Chiropractic Education and Radiography Best Practices,” October 2018

“Choosing Wisely: Separating Facts from Fears,” September 2018

“Choosing Wisely: Beyond the Myth,” Webinar, September 2018

“Choosing Wisely X-ray Recommendations Reflect Evolving Evidence, Accepted Standards,” August 2017

Frequently Asked Questions (PDF)

Endorsement by Clinical Compass (PDF)

About Choosing Wisely:

About ABIM Foundation:

How The Recommendations Were Created

The American Chiropractic Association (ACA) utilized its Committee on Quality Assurance and Accountability (CQAA) to serve as an expert task force of doctors of chiropractic (DCs) to identify areas/items common to the practice of chiropractic for which recommendations were supported by clinical research and would result in high-value, cost-effective services and improved patient outcomes. A literature search was conducted and the task force collaboratively identified a draft list of six recommendations based upon established Choosing Wisely® criteria. The list was submitted to the ACA Board of Governors for initial review. After further refinement, the final list of five strategies was selected, submitted to and approved by the ACA Board of Governors.