Clinical management of occupational low back pain in Australia: what is the real picture?
BACKGROUND
The aim of this study was to compare the clinical management of patients with occupational low back pain (LBP) presenting to secondary care practitioners in Australia with national and international practice guidelines.


METHODS
A consecutive cohort of 401 patients with LBP following a work injury was assembled at the time of referral to secondary rehabilitation. A comprehensive assessment was performed to collect demographic, clinical and occupational data, which were analysed using descriptive statistics. Clinical and occupational management data were compared with evidence-based guidelines for the management of LBP.


RESULTS
This study revealed that in this cohort presenting to secondary care, referral for guideline-based active treatment was delayed until, on average, 10 months post-injury; radiographic investigations had been ordered for almost every patient, including those presenting in the first three months of their injury; the prevalence of co-morbidities was high and there were signs that psychological distress was under-diagnosed.


CONCLUSIONS
This study reveals a lack of compliance with clinical guidelines for occupational back pain management in Australia.
Hush
Julia M
JM
Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia. j.hush@usyd.edu.au
D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D005239:Fear / Q000523:psychology; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D009784:Occupational Diseases / Q000175:diagnosis* / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D017410:Practice Guidelines as Topic; D013315:Stress, Psychological / Q000150:complications; D011795:Surveys and Questionnaires; D055815:Young Adult
Spine (Phila Pa 1976). 2006 Mar 15;31(6):682-9
16540874
J Manipulative Physiol Ther. 2004 May;27(4):238-44
15148462
Behav Res Ther. 1995 Mar;33(3):335-43
7726811
Spine J. 2004 Jan-Feb;4(1):56-63
14749194
BMJ. 1999 Jun 19;318(7199):1662-7
10373170
J Occup Environ Med. 2005 Jun;47(6):607-22
15951721
Spine (Phila Pa 1976). 1995 Mar 15;20(6):722-8
7604349
Pain. 2006 Sep;124(1-2):140-9
16707222
Eur Spine J. 2006 Mar;15 Suppl 2:S192-300
16550448
Spine (Phila Pa 1976). 2001 Jan 1;26(1):78-86; discussion 87
11148650
Eur J Pain. 2007 Nov;11(8):841-54
17314055
Pain. 2000 Sep;87(3):285-294
10963908
BMJ. 2008 Jul 07;337:a171
18614473
Ann Intern Med. 2005 May 3;142(9):765-75
15867409
Epidemiology. 1999 Sep;10(5):626-31
10468442
Aust J Physiother. 2007;53(4):269-76
18047462
J Occup Rehabil. 2005 Dec;15(4):451-2
16254747
Lancet. 2007 Nov 10;370(9599):1638-43
17993364
Pain. 1993 Feb;52(2):157-168
8455963
Occup Med (Lond). 2001 Mar;51(2):124-35
11307688
BMJ. 2001 Feb 17;322(7283):400-5
11179160