title: Adherence to Back Pain Clinical Practice Guidelines by Brazilian Physical Therapists: A Cross-sectional Study.
abstract: METHODS
  This was a cross-sectional observational study.
  
  
  OBJECTIVE
  (i) to investigate whether Brazilian physical therapists make clinical decisions for patients with low back pain based upon clinical practice guidelines and (ii) to determine whether the physical therapists are able to recognize differential diagnoses of low back pain associated with red or yellow flags.
  
  
  BACKGROUND
  Early adherence to clinical practice guidelines may accelerate recovery and reduce the costs associated with low back pain. It is unknown whether Brazilian physical therapists follow clinical practice guidelines to make their clinical decisions in the treatment of patients with low back pain.
  
  
  METHODS
  The sample consisted of physical therapists from two Brazilian physical therapy associations. The data were collected via electronic survey and face-to-face interviews. The survey was composed of six hypothetical clinical cases of low back pain, which served as a basis to evaluate clinical decisions and adherence to clinical practice guidelines for low back pain. The study participants had 27 possible answers for each clinical case and could choose up to five answers. The results were analyzed in three ways: full adherence, partial adherence, or no adherence to the recommendations from clinical practice guidelines.
  
  
  RESULTS
  A total of 530 physical therapists were invited and 189 participated in the study (response rate = 35.6%). Full adherence to the guidelines was low for all six cases (rates ranging from 5%-24%). Partial adherence to the guidelines was higher when compared with full adherence (rates ranging from 32%-75%). The participants were more likely to identify differential diagnoses associated with yellow flags than with red flags.
  
  
  CONCLUSIONS
  Brazilian physical therapists are not using the best available evidence in their clinical decision making for patients with low back pain. Wider dissemination of clinical practice guidelines should be urgently undertaken.
  
  
  METHODS
  2.
authors.affiliation: Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
authors.forename: Fabrício S
authors.initials: FS
authors.lastname: de Souza
authors.affiliation: University of St. Augustine for Health Sciences, Doral, Florida, US.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Ladeira
authors.affiliation: Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.|Musculoskeletal Division, George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: Leonardo O P
authors.initials: LOP
authors.lastname: Costa
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D059825:Physical Therapists / Q000592:standards*; D026741:Physical Therapy Modalities / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D011795:Surveys and Questionnaires