title: Training in back care to improve outcome and patient satisfaction. Teaching old docs new tricks.
abstract: BACKGROUND
  We examined clinical outcomes and patient perceptions of back care given by physicians before and after an intensive course of training in back care and limited manual therapy techniques.
  
  
  METHODS
  From a prospective observational cohort study of low back pain involving 208 physicians (115 primary care) and their patients and a subsequent clinical trial of treatment of low back pain given by 31 physicians specially trained in manual therapy and enhanced back care, outcome data from the patients of 13 physicians participating in both studies were compared. In the observational study, the 13 physicians cared for 120 patients. In the manual therapy trial (191 patients) a control group of 94 patients received enhanced back care and an intervention group of 97 patients received enhanced back care plus manual therapy. Pearson's chi-square comparisons and linear and Cox proportional hazard modeling were used to examine effects of variables and recovery time.
  
  
  RESULTS
  Characteristics of the 13 physicians' patients in the cohort group and the manual therapy trial showed some differences in income, workers' compensation, previous employment, and baseline dysfunction. Both control and intervention patients in the manual therapy trial showed more rapid improvement in functional status over time and greater satisfaction with their care than those in the previous cohort study. However, there was no difference between the studies in patient-reported time to return to performing usual daily activities.
  
  
  CONCLUSIONS
  A structured clinical approach to low back care may bring modestly improved clinical outcomes and patient satisfaction.
authors.affiliation: Department of Family Medicine, University of North Carolina at Chapel Hill, 27599, USA. fmcurtis@med.urc.edu
authors.forename: P
authors.initials: P
authors.lastname: Curtis
authors.forename: T S
authors.initials: TS
authors.lastname: Carey
authors.forename: P
authors.initials: P
authors.lastname: Evans
authors.forename: M P
authors.initials: MP
authors.lastname: Rowane
authors.forename: A
authors.initials: A
authors.lastname: Jackman
authors.forename: J
authors.initials: J
authors.lastname: Garrett
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004502:Education, Medical, Continuing; D005194:Family Practice / Q000193:education*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008349:Manipulation, Orthopedic / Q000523:psychology; D008875:Middle Aged; D009657:North Carolina; D019370:Observation; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome