Orthopaedists' and family practitioners' knowledge of simple low back pain management.
METHODS
Comparative knowledge survey.


OBJECTIVE
This study compared the knowledge of orthopaedic surgeons and family practitioners in managing simple low back pain (LBP) with reference to currently published guidelines.


BACKGROUND
LBP is the most prevalent of musculoskeletal conditions. It affects nearly everyone at some point in time and about 4% to 33% of the population at any given point. Treatment guidelines for LBP should be based on evidence-based medicine and updated to improve patient management and outcome. Studies in various fields have assessed the impact of publishing guidelines on patient management, but little is known about the physicians' knowledge of the guidelines.


METHODS
Orthopedic surgeons and family practitioners participating in their annual professional meetings were requested to answer a questionnaire regarding the management of simple low back pain. Answers were scored based on the national guidelines for management of low back pain.


RESULTS
One hundred forty family practitioners and 253 orthopaedists responded to the questionnaire. The mean family practitioners' score (69.7) was significantly higher than the orthopaedists' score (44.3) (P < 0.0001). No relation was found between the results and physician demographic factors, including seniority. Most orthopaedists incorrectly responded that they would send their patients for radiologic evaluations. They would also preferentially prescribe cyclo-oxygenase-2-specific nonsteroidal anti-inflammatory drugs, despite the guidelines recommendations to use paracetamol or nonspecific nonsteroidal anti-inflammatory drugs. Significantly less importance was attributed to patient encouragement and reassurance by the orthopaedists as compared with family physicians.


CONCLUSIONS
Both orthopaedic surgeons' and family physicians' knowledge of treating LBP is deficient. Orthopedic surgeons are less aware of current treatment than family practitioners. Although the importance of publishing guidelines and keeping them up-to-date and relevant for different disciplines in different countries cannot be overstressed, disseminating the knowledge to clinicians is also very important to ensure good practice.
Finestone
Aharon S
AS
Department of Orthopaedics, Assaf HaRofeh Medical Center, Zeriffin, Israel. asff@inter.net.il
Raveh
Avraham
A
Mirovsky
Yigal
Y
Lahad
Amnon
A
Milgrom
Charles
C
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D005194:Family Practice / Q000706:statistics & numerical data* / Q000639:trends; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy*; D009140:Musculoskeletal Diseases / Q000534:rehabilitation; D019637:Orthopedic Procedures; D009985:Orthopedics / Q000706:statistics & numerical data* / Q000639:trends; D010147:Pain Measurement; D026761:Physical Therapy Specialty; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D011871:Radiology / Q000592:standards / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014938:Work Capacity Evaluation
D000894:Anti-Inflammatory Agents, Non-Steroidal