title: Acute low back pain management in general practice: uncertainty and conflicting certainties.
abstract: BACKGROUND
  Low back pain (LBP) is a significant health problem and common reason to visit the GP. Evidence suggests GPs experience difficulty applying evidence-based guidelines.
  
  
  OBJECTIVE
  Explore GPs' underlying beliefs about acute LBP and how these influence their clinical management of patients.
  
  
  METHODS
  Eleven GPs from one geographical region within New Zealand were recruited by purposive sampling. Audio recordings of semi-structured qualitative interviews were transcribed verbatim. Data were analysed with an Interpretive Description framework.
  
  
  RESULTS
  Four key themes emerged related to the causes of acute LBP, GP confidence, communicating diagnostic uncertainty and encouraging movement and activity. Acute LBP was seen as a direct representation of tissue injury, consequently the assessment and management of patients' attitudes and beliefs was not a priority. Participants' confidence was decreased due to a perceived inability to diagnose or influence the tissue injury. Despite this, diagnoses were provided to patients to provide reassurance and meet expectations. Guideline recommendations regarding activity conflicted with a perceived need to protect damaged tissue, resulting in reported provision of mixed messages about the need to be both active and careful.
  
  
  CONCLUSIONS
  GPs' initial focus upon tissue injury during acute care, and providing a diagnostic label, may influence patients' subsequent alignment with a biomedical perspective and contribute to consultation conflict and patients' perception of blame when discussion of psychosocial influences is introduced. Demonstrating the relevance of the biopsychosocial model to acute LBP may improve GPs' alignment with guidelines, improve their confidence to manage these patients and ultimately improve outcomes.
authors.affiliation: Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand, ben.darlow@otago.ac.nz.
authors.forename: Ben
authors.initials: B
authors.lastname: Darlow
authors.affiliation: Institute of Health Research, University of Exeter Medical School, Exeter EX2 4SG, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dean
authors.affiliation: Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, PO Box 56, Dunedin 9054 and.
authors.forename: Meredith
authors.initials: M
authors.lastname: Perry
authors.affiliation: Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand.
authors.forename: Fiona
authors.initials: F
authors.lastname: Mathieson
authors.affiliation: Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, PO Box 56, Dunedin 9054 and.
authors.forename: G David
authors.initials: GD
authors.lastname: Baxter
authors.affiliation: Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand.
authors.forename: Anthony
authors.initials: A
authors.lastname: Dowell
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D055317:Evidence-Based Practice / Q000379:methods / Q000592:standards*; D005260:Female; D058006:General Practice / Q000379:methods / Q000592:standards*; D058005:General Practitioners / Q000523:psychology* / Q000592:standards; D019983:Guideline Adherence / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D059408:Pain Management / Q000379:methods / Q000592:standards*; D036301:Qualitative Research
keywords: Attitudes; general practice; guideline adherence; health knowledge; low back pain; practice; qualitative research.