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General practitioners' management of acute back pain: a survey of reported practice compared with clinical guidelines

General practitioners' management of acute back pain: a survey of reported practice compared with clinical guidelines
General practitioners' management of acute back pain: a survey of reported practice compared with clinical guidelines
Objective: To compare general practitioners' reported management of acute back pain with “evidence based” guidelines for its management.

Design: Confidential postal questionnaire.

Setting: One health district in the South and West region.

Subjects: 236 general practitioners; 166 (70%) responded.

Outcome measures: Examination routinely performed, “danger” symptoms and signs warranting urgent referral, advice given, and satisfaction with management.

Results: A minority of general practitioners do not examine reflexes routinely (27%, 95% confidence interval 20% to 34%), and a majority do not examine routinely for muscle weakness or sensation. Although most would refer patients with danger signs, some would not seek urgent advice for saddle anaesthesia (6%, 3% to 11%), extensor plantar response (45%, 37% to 53%), or neurological signs at multiple levels (15%, 10% to 21%). A minority do not give advice about back exercises (42%, 34% to 49%), fitness (34%, 26% to 41%), or everyday activities. A minority performed manipulation (20%) or acupuncture (6%). One third rated their satisfaction with management of back pain as 4 out of 10 or less.

Conclusions: The management of back pain by general practitioners does not match the guidelines, but there is little evidence from general practice for many of the recommendations, including routine examination, activity modification, educational advice, and back exercises. General practitioners need to be more aware of danger symptoms and of the benefits of early mobilisation and possibly of manipulation for persisting symptoms. Guidelines should reference each recommendation and discuss study methodology and the setting of evidence.
0959-8138
485-488
Little, P.S.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Smith, L.
0a937943-5246-4877-bd6b-4dcd172b5cd0
Cantrell, T.
bdf6cfe6-f756-4d5c-b234-445b6e9fd438
Chapman, J.
b47dbd01-ff25-46e5-b579-f1aeed773c47
Langridge, J.
0ea09e72-6d55-4d10-a0a2-6d92fbe826dd
Pickering, R.
4a828314-7ddf-4f96-abed-3407017d4c90
Little, P.S.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Smith, L.
0a937943-5246-4877-bd6b-4dcd172b5cd0
Cantrell, T.
bdf6cfe6-f756-4d5c-b234-445b6e9fd438
Chapman, J.
b47dbd01-ff25-46e5-b579-f1aeed773c47
Langridge, J.
0ea09e72-6d55-4d10-a0a2-6d92fbe826dd
Pickering, R.
4a828314-7ddf-4f96-abed-3407017d4c90

Little, P.S., Smith, L., Cantrell, T., Chapman, J., Langridge, J. and Pickering, R. (1996) General practitioners' management of acute back pain: a survey of reported practice compared with clinical guidelines. British Medical Journal, 312 (7029), 485-488. (doi:10.1136/bmj.312.7029.485). (PMID:8597683)

Record type: Article

Abstract

Objective: To compare general practitioners' reported management of acute back pain with “evidence based” guidelines for its management.

Design: Confidential postal questionnaire.

Setting: One health district in the South and West region.

Subjects: 236 general practitioners; 166 (70%) responded.

Outcome measures: Examination routinely performed, “danger” symptoms and signs warranting urgent referral, advice given, and satisfaction with management.

Results: A minority of general practitioners do not examine reflexes routinely (27%, 95% confidence interval 20% to 34%), and a majority do not examine routinely for muscle weakness or sensation. Although most would refer patients with danger signs, some would not seek urgent advice for saddle anaesthesia (6%, 3% to 11%), extensor plantar response (45%, 37% to 53%), or neurological signs at multiple levels (15%, 10% to 21%). A minority do not give advice about back exercises (42%, 34% to 49%), fitness (34%, 26% to 41%), or everyday activities. A minority performed manipulation (20%) or acupuncture (6%). One third rated their satisfaction with management of back pain as 4 out of 10 or less.

Conclusions: The management of back pain by general practitioners does not match the guidelines, but there is little evidence from general practice for many of the recommendations, including routine examination, activity modification, educational advice, and back exercises. General practitioners need to be more aware of danger symptoms and of the benefits of early mobilisation and possibly of manipulation for persisting symptoms. Guidelines should reference each recommendation and discuss study methodology and the setting of evidence.

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More information

Published date: 24 February 1996
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 350908
URI: https://eprints.soton.ac.uk/id/eprint/350908
ISSN: 0959-8138
PURE UUID: a1dfb7b3-f3a6-4ecd-b8ee-e8fea2c44e95

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Date deposited: 10 Apr 2013 12:22
Last modified: 16 Jul 2019 21:38

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