title: Management of LBP at primary care level in South Africa: up to standards?
abstract: BACKGROUND
  Primary Health Care (PHC) is well suited for management of low back pain (LBP). Prevalence of (chronic) LBP is suspected to be high among visitors of the South African primary care centers, but currently no information exists on prevalence or guideline adherence.
  
  
  OBJECTIVE
  To establish if treatment received for LBP in public PHC in the Cape Town area compares with international evidence based guidelines.
  
  
  METHODS
  Cluster randomization determined the 8 community health centres where the study took place. A measurement tool was developed and validated for this population. Descriptive analysis and logistic regression analytical techniques were applied.
  
  
  RESULTS
  489 participants (mean age: 44.8) were included in this study. Lifetime prevalence was 73.2% and 26.3% suffered from chronic low back pain (CLBP) . Pain medication was the only form of treatment received by 90% of the sample. Interventions received seemed to be unrelated to type of LBP (acute, sub acute and chronic). Referral to physiotherapy, education and advice to stay active were rarely done. Participants expressed low satisfaction with treatment.
  
  
  CONCLUSIONS
  Current management of LBP at PHC level appears to be ineffective and not conform guidelines. Further South African research should focus on barriers as well as measures to be taken for implementation of LBP guidelines.
authors.affiliation: Physiotherapy division, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, 7505 Cape Town, South Africa ; European School of Physiotherapy, Amsterdam University of Applied Sciences/Hogeschool van Amsterdam, PO Box 2557, 1000 CN Amsterdam, the Netherlands.
authors.forename: Mel E
authors.initials: ME
authors.lastname: Major-Helsloot
authors.affiliation: Physiotherapy division, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, 7505 Cape Town, South Africa.
authors.forename: Lynette C
authors.initials: LC
authors.lastname: Crous
authors.affiliation: Physiotherapy division, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, 7505 Cape Town, South Africa ; International Centre for Allied Health Evidence, University of South Australia, School of Health Sciences, GPO Box 2471, Adelaide SA 5001, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Grimmer-Somers
authors.affiliation: Physiotherapy division, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, 7505 Cape Town, South Africa.
authors.forename: Quinette A
authors.initials: QA
authors.lastname: Louw
mesh_terms: D000328:Adult; D003151:Community Health Centers / Q000458:organization & administration*; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D011446:Prospective Studies; D012017:Referral and Consultation; D013019:South Africa
keywords: Low back pain; South Africa; guidelines; management; primary care