title: Providing services for acute low-back pain: A survey of Australian physiotherapists.
abstract: OBJECTIVE
  To determine whether physiotherapists avoid lumbar X-rays for acute non-specific low back pain and advise people to stay active.
  
  
  METHODS
  We conducted a cross sectional survey of Australian physiotherapists. 880 physiotherapists were randomly sampled from Victoria (495), South Australia (158), and Western Australia (227). Physiotherapists were asked which investigations they would order and interventions they would provide for five acute low back pain (LBP) presentations described in vignettes. Four of the five vignettes represented people who would not require a plain lumbar X-ray and would benefit from advice to stay active; one described a patient with a suspected vertebral fracture and would require a plain X-ray. Participants selected from a list of response options or provided free text responses.
  
  
  RESULTS
  Questionnaires were completed by 203 of 567 potentially eligible physiotherapists (response rate 36%). Across the four vignettes where an X-ray was not indicated, 75% (95%CI 71-78%) of physiotherapists reported they would practice concordant with the guidelines and not order an X-ray, and 62% (95%CI 57-66%) provided advice to stay active.
  
  
  CONCLUSIONS
  Most physiotherapists report intended compliance with recommendations in Australian clinical practice guidelines (CPGs) regarding avoiding the use of X-rays and providing advice to stay active for people with simple acute low back pain, given a vignette based scenario. The majority of respondents reported that they would not advise bed rest. Possible opportunities to further enhance compliance need to be developed and tested to reinforce the role of CPGs in informing physiotherapy practice.
authors.affiliation: Department of Physiotherapy, Monash University, Victoria 3800, Australia. Electronic address: jenny.keating@monash.edu.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Keating
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Victoria 3800, Australia. Electronic address: joanne.mckenzie@monash.edu.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: McKenzie
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Victoria 3800, Australia. Electronic address: denise.oconnor@monash.edu.
authors.forename: Denise A
authors.initials: DA
authors.lastname: O'Connor
authors.affiliation: School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, 99 University Avenue, Kingston, Ontario K7L 3N6, Canada. Electronic address: simon.french@queensu.ca.
authors.forename: Simon
authors.initials: S
authors.lastname: French
authors.affiliation: School of Health Professions, Murdoch University, 90 South Street, Murdoch, Perth, Western Australia 6150, Australia. Electronic address: Bruce.Walker@murdoch.edu.au.
authors.forename: Bruce F
authors.initials: BF
authors.lastname: Walker
authors.affiliation: Institute of Sport Exercise and Active Living, Victoria University, Australia; School of Health Sciences, Federation University, PO Box 663, Ballarat, VIC 3353 Australia. Electronic address: melanie.charity@federation.edu.au.
authors.forename: Melanie
authors.initials: M
authors.lastname: Charity
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Victoria 3800, Australia. Electronic address: matthew.page@monash.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Page
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Victoria 3800, Australia. Electronic address: sally.green@monash.edu.
authors.forename: Sally E
authors.initials: SE
authors.lastname: Green
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D059825:Physical Therapists / Q000592:standards*; D026741:Physical Therapy Modalities / Q000592:standards*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Acute low back pain; Behaviour; Clinical practice guideline; Physiotherapists; Survey