Abstract
Objectives
Chronic low back pain (CLBP) is one of the leading causes of disability worldwide and its related healthcare costs are constantly increasing. Imaging studies have limited clinical utility in managing this condition and their overuse can lead to negative effects on patients. Clinicians' and patients' misconceptions seem to be one of the main drivers of such unnecessary use. However, there is a lack of research investigating osteopaths' views on imaging. This study explored Italian osteopaths’ attitudes and beliefs towards imaging and its utilisation in the clinical evaluation and management of CLBP patients.

Methods
A qualitative study, using elements of constructivist grounded theory, was conducted by means of semi-structured interviews. A purposive sampling approach was used to recruit 14 osteopaths practising in Italy with clinical and educational experiences. Data were collected until real saturation, transcribed verbatim and coded by using qualitative thematic analysis identifying categories, concepts and themes.

Results
Two main themes were identified with seven subcategories. The overarching themes were 1) Clinical relevance and utility; 2) Interacting with the patient through a biopsychosocial perspective.

Conclusion
The findings highlight that imaging plays a marginal role in the interviewed osteopaths' clinical practice, except for ruling out red flags or contraindications for treatment. Participants have shown awareness about the potential negative effects of imaging in CLBP patients. They underlined the need to reassure and educate patients to minimise the psycho-behavioural impact of diagnostic investigations on patients’ condition and also to provide a clinical value of their use, especially in relation to the complex and multidimensional nature of CLBP.