• J Gen Intern Med · Dec 2005

    Comparative Study

    Physicians' initial management of acute low back pain versus evidence-based guidelines. Influence of sciatica.

    • Barbara S Webster, Theodore K Courtney, Yueng-Hsiang Huang, Simon Matz, and David C Christiani.
    • Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA 01748, USA. barbara.webster@libertymutual.com
    • J Gen Intern Med. 2005 Dec 1;20(12):1132-5.

    BackgroundLittle information is available on physician characteristics and patient presentations that may influence compliance with evidence-based guidelines for acute low back pain.ObjectiveTo assess whether physicians' management decisions are consistent with the Agency for Health Research Quality's guideline and whether responses varied with the presentation of sciatica or by physician characteristics.DesignCross-sectional study using a mailed survey.ParticipantsParticipants were randomly selected from internal medicine, family practice, general practice, emergency medicine, and occupational medicine specialties.MeasurementsA questionnaire asked for recommendations for 2 case scenarios, representing patients without and with sciatica, respectively.ResultsSeven hundred and twenty surveys were completed (response rate=25%). In cases 1 (without sciatica) and 2 (with sciatica), 26.9% and 4.3% of physicians fully complied with the guideline, respectively. For each year in practice, the odds of guideline noncompliance increased 1.03 times (95% confidence interval [CI]=1.01 to 1.05) for case 1. With occupational medicine as the referent specialty, general practice had the greatest odds of noncompliance (3.60, 95% CI=1.75 to 7.40) in case 1, followed by internal medicine and emergency medicine. Results for case 2 reflected the influence of sciatica with internal medicine having substantially higher odds (vs case 1) and the greatest odds of noncompliance of any specialty (6.93, 95% CI=1.47 to 32.78), followed by family practice and emergency medicine.ConclusionsA majority of primary care physicians continue to be noncompliant with evidence-based back pain guidelines. Sciatica dramatically influenced clinical decision-making, increasing the extent of noncompliance, particularly for internal medicine and family practice. Physicians' misunderstanding of sciatica's natural history and belief that more intensive initial management is indicated may be factors underlying the observed influence of sciatica.

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