Survey of acute low back pain management by specialty group and practice experience.
OBJECTIVE
The objective of this study was to explore concurrence with evidence-based management of acute back pain by primary care specialty and years in practice groups.


METHODS
Participants randomly selected from five American Medical Association physician groups were surveyed asking their initial care recommendations for case scenarios with and without sciatica. Response differences were compared among groups and with the Agency for Health Research Quality's guideline.


RESULTS
Response rate was 25%. Emergency physicians were least likely to order diagnostic studies for both cases but more often made recommendations likely to promote inactivity. Occupational physicians were less likely to order diagnostic studies and more likely choose treatments conducive to increasing activity. The longer physicians were in practice, the less likely they were to follow recommendations. All specialty groups selected more nonevidence-based interventions for the patient with sciatica. General practitioners were least likely to follow the guidelines in either case.


CONCLUSIONS
Despite widespread dissemination of acute low back pain guidelines, the study suggests a lack of adherence by certain primary care groups, physicians with more practice experience, and in specific areas of management.
Webster
Barbara S
BS
Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts 01748, USA. barbara.webster@libertymutual.com
Courtney
Theodore K
TK
Huang
Yueng-Hsiang
YH
Matz
Simon
S
Christiani
David C
DC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008511:Medicine; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D013038:Specialization