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.


METHODS
Confidential postal questionnaire.


METHODS
One health district in the South and West region.


METHODS
236 general practitioners; 166 (70%) responded.


METHODS
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.
Little
P
P
Primary Care, Faculty of Medicine, Health, and Biological Sciences, University of Southampton.
Smith
L
L
Cantrell
T
T
Chapman
J
J
Langridge
J
J
Pickering
R
R
D000208:Acute Disease; D001416:Back Pain / Q000175:diagnosis / Q000628:therapy*; D004739:England; D005194:Family Practice; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D011795:Surveys and Questionnaires