title: Factors impacting on doctors' management of acute low back pain: a systematic review.
abstract: The aim of this review was to determine the factors that impact on doctors' management of patients with acute low back pain. A methodological assessment of databases (Medline, EMBASE, Psychinfo, BIOSIS, CINAHL, and the Cochrane Central Register of Controlled Trials) identified papers which were screened for inclusion criteria by two independent reviewers. Data were extracted from accepted papers, and the internal validity and strength of the evidence were determined using valid and reliable scales. The search generated a total of 28 papers [quantitative (n=27), qualitative (n=1) methodologies]. Themes were identified from the accepted papers: education (n=18), knowledge of clinical guidelines and impact on management (n=7), and doctors' demographics (n=4). There was consistent evidence that doctors did not adhere to clinical guidelines when performing a spinal assessment. There was inconsistent evidence that education increased adherence with acute LBP guideline recommendations in terms of referral rates to physiotherapy, for investigations, to secondary care and for maintaining patients at work. Strategies to address the factors impacting on doctors' management of acute LBP are required; these would lead to improvement in patient outcomes and reduce healthcare costs.
authors.affiliation: School of Physiotherapy and Performance Science, University College Dublin, Ireland. brona.fullen@ucd.ie
authors.forename: Brona M
authors.initials: BM
authors.lastname: Fullen
authors.forename: G David
authors.initials: GD
authors.lastname: Baxter
authors.forename: Barry G G
authors.initials: BG
authors.lastname: O'Donovan
authors.forename: Catherine
authors.initials: C
authors.lastname: Doody
authors.forename: Leslie E
authors.initials: LE
authors.lastname: Daly
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Hurley
mesh_terms: D000208:Acute Disease / Q000191:economics / Q000534:rehabilitation / Q000628:therapy; D019983:Guideline Adherence / Q000706:statistics & numerical data / Q000639:trends*; D017048:Health Care Costs / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy / Q000191:economics / Q000534:rehabilitation*; D010353:Patient Education as Topic / Q000706:statistics & numerical data / Q000639:trends; D026761:Physical Therapy Specialty / Q000706:statistics & numerical data / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D055656:Prescriptions / Q000191:economics / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data / Q000639:trends