title: Acute low back pain management in primary care: a simulated patient approach.
abstract: BACKGROUND
  Recent medical guidelines for acute low back pain (aLBP) are unevenly followed. Based on financial criteria or associated with a desirability bias, studies incompletely describe the actual management provided by general practitioners (GPs) in terms of diagnosis, treatment and prevention of progression towards chronicity.
  
  
  OBJECTIVE
  To compare actual practices of French GPs for aLBP management with clinical guidelines.
  
  
  METHODS
  A young simulated patient (SP) consulted, using a single scenario of aLBP, in 30 primary care practices in the Paris region.
  
  
  RESULTS
  Heterogeneous data were collected according to the grid items: during the questioning, 29 GPs (97%) asked for age and 1 GP (3%) for pregnancy; during the clinical examination, 21 GPs (70%) asked for spinal stiffness and 3 GPs (10%) for cauda equina syndrome. Non-steroidal anti-inflammatory drugs were prescribed by 27 GPs (90%). Imaging (2 GPs or 7%) and physiotherapy (3 GPs or 10%) was rarely prescribed. A sick leave was prescribed by 22 GPs (73%). Twenty-seven GPs (90%) reassured the patient.
  
  
  CONCLUSIONS
  aLBP management was in line with international guidelines in terms of clinical examination, physiotherapy and imaging prescriptions and some risk factors for chronicity were taken into account. However, patient questioning was brief, and drug and sick leave prescriptions did not meet international guidelines. The SP approach seems to be a useful tool for assessing actual GP practices.
authors.affiliation: Faculty of Medicine, Department of General Practice, Université Paris Descartes, Sorbonne Paris Cité, Paris and alain.lorenzo@parisdescartes.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Lorenzo
authors.affiliation: Faculty of Medicine, Department of General Practice, Université Paris Descartes, Sorbonne Paris Cité, Paris and.
authors.forename: Pauline
authors.initials: P
authors.lastname: Schildt
authors.affiliation: Faculty of Medicine, Department of General Practice, Université de Strasbourg, Strasbourg, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Lorenzo
authors.affiliation: Faculty of Medicine, Department of General Practice, Université Paris Descartes, Sorbonne Paris Cité, Paris and.
authors.forename: Hector
authors.initials: H
authors.lastname: Falcoff
authors.affiliation: Faculty of Medicine, Department of General Practice, Université Paris Descartes, Sorbonne Paris Cité, Paris and.
authors.forename: Fréderique
authors.initials: F
authors.lastname: Noel
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D058005:General Practitioners; D019983:Guideline Adherence; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000628:therapy*; D059408:Pain Management; D010297:Paris; D026741:Physical Therapy Modalities; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D018582:Sick Leave
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Consultation; low back pain; practice management; primary care; quality of care; teaching methods.