title: General practitioners' management of low back pain: impact of clinical guidelines in a non-English-speaking country.
abstract: METHODS
  Cross-sectional.
  
  
  OBJECTIVE
  To evaluate the assessment of patients with low back pain by general practitioners (GPs) in a non-English-speaking country and to compare their behavior with AHCPR and CSAG clinical guidelines.
  
  
  BACKGROUND
  The diffusion of clinical guidelines (and their everyday application by health care professionals) is a significant problem. Because most guidelines are developed in English, concerns over their diffusion are obviously greater in non-English-speaking countries.
  
  
  METHODS
  A questionnaire was sent to all the GPs in the province of Mantua, Italy (n = 318). The authors evaluated what examinations are routinely performed and what danger symptoms and signs prompt referral of patients. GPs indicated the frequency of their prescription of radiographs, computed tomography scans, magnetic resonance imaging, laboratory tests, and consultations. The findings were compared with a "gold standard": the AHCPR and CSAG clinical guidelines.
  
  
  RESULTS
  The response rate was 68.2%. Only 28.0% of GPs perform all the tests considered important by the clinical guidelines, and 33.0% were aware of all the red flags. Correspondence with the clinical guideline recommendations ranged from 14.6% to 89.4%. There is a clear tendency to overprescribe examinations in acute cases, whereas in chronic cases underprescription is sometimes seen.
  
  
  CONCLUSIONS
  In a non-English-speaking country the evaluation of low back pain by GPs does not reflect current recommendations, and the situation is seen to be worse than in English-speaking countries. Concerns over the diffusion of guidelines must therefore be considered greater in non-English-speaking countries, where thorough presentation to GPs of the existing "evidence-based" guidelines is to be recommended.
authors.affiliation: Rehabilitation Unit, Don Carlo Gnocchi Foundation ON-LUS, Care & Research Institute, Milan, Italy. snegrini@dongnocchi.it
authors.forename: S
authors.initials: S
authors.lastname: Negrini
authors.forename: E
authors.initials: E
authors.lastname: Politano
authors.forename: R
authors.initials: R
authors.lastname: Carabalona
authors.forename: A
authors.initials: A
authors.lastname: Mambrini
mesh_terms: D003430:Cross-Sectional Studies; D004059:Diffusion of Innovation; D005194:Family Practice / Q000379:methods*; D019983:Guideline Adherence; D006801:Humans; D007558:Italy; D017116:Low Back Pain / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires