Physical therapy management of low back pain: an exploratory survey of therapist approaches.
OBJECTIVE
Since the release of acute low back pain management guidelines in 1994, little was known about the effect of these guidelines on clinical practice. The purpose of this study was to examine physical therapists' reported management of acute and subacute lumbar impairment.


METHODS
One in 10 registered physical therapists who were randomly selected from southern Ontario, Canada, (n=454) and all registered physical therapists from northern Ontario (n=331) were surveyed.


METHODS
In the questionnaire, case scenarios covered 3 areas related to the management of lumbar impairment: (1) physical examination, (2) treatment and recommendations, and (3) therapists' beliefs regarding its management.


RESULTS
Five hundred sixty-nine questionnaires were returned (response rate=72.5%). Only data obtained for therapists (n=274) whose weekly workload included more than 10% of people with lumbar impairment were used in the analysis. Overall, patient education, exercise, and electrotherapeutic and thermal modalities were the preferred interventions for acute lumbar impairment (symptom onset of less than 5 weeks) with or without sciatica, whereas exercise and work modification were preferred for subacute lumbar impairment (symptom onset of 5 weeks or longer). There was a trend of using electrotherapeutic and thermal modalities with uncertain effectiveness. Only 46.3% of the therapists agreed or strongly agreed that practice guidelines were useful for managing lumbar impairment.


CONCLUSIONS
Although the physical therapists surveyed, in general, followed the guidelines in managing acute lumbar impairment, they felt uncertain regarding the value of practice guidelines. Future research should focus on identifying effective treatment approaches and exploring the effectiveness of practice guidelines.
Health Care Research Division, Arthritis & Autoimmunity Research Centre, University Health Network, 610 University Ave, 16th Floor, Toronto, Ontario, Canada M5G 2M9. lli@netcom.ca
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D000208:Acute Disease; D000328:Adult; D001291:Attitude of Health Personnel; D001510:Bed Rest; D001915:Braces; D002908:Chronic Disease; D004599:Electric Stimulation Therapy / Q000379:methods; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006358:Hot Temperature / Q000627:therapeutic use; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods; D008875:Middle Aged; D009864:Ontario; D010808:Physical Examination; D026741:Physical Therapy Modalities / Q000379:methods* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014143:Traction