Objective-To compare general practitioners' reported management of acute back pain with "evidence based" guidelines for its management.Design-Confidential postal questionnaire. A minority performed manipulation (201/6) or acupuncture (6%). One third rated their satisfaction with management ofback pain as 4 out of 10 or less. Conclusions-The management of back pain by general practitioners does not match the guidelines, but there is little evidence from general practice for many of the recommendations, including routine examination, activity modification, educational advice, and back exercises. General practitioners need to be more aware of danger symptoms and of the benefits of early mobilisation and possibly of manipulation for persisting symptoms. Guidelines should reference each recommendation and discuss study methodology and the setting ofevidence. IntroductionBack pain is one of the commonest conditions managed in primary care, responsible each year for about 12 million general practitioner consultations, over 50 million work days lost, and almost £500m costs to the NHS.' Few management strategies for back pain have been proved in primary care, partly because most cases settle within a few weeks.2Given that most episodes of back pain settle with
Study Design. A single-blind randomized controlled trial of a leaflet developed for people with acute low back pain was compared with the usual general practitioner management of back pain.Objective. To test the effectiveness of a patient information leaflet on knowledge, attitude, behavior, and function.Summary of Background Data. Despite the commonality of back pain in general practice, little evidence on the effectiveness of simple interventions such as leaflets and advice on self-management has been reported. On the basis of a five-stage needs analysis, a simple leaflet was developed that considered the views of patients and health professionals.Methods. For this study, 64 patients with acute back pain were assigned to the leaflet or control group. The participants were visited at home after 2 days, 2 weeks, then 3, 6, and 12 months, where they completed a range of self-report measures. Behavioral aspects were discreetly recorded by a "blinded" researcher. Primary outcomes were knowledge, attitude, behavior, and function.Results. In all, 272 home visits were undertaken. The findings show that at 2 weeks, knowledge about sitting posture was greater in the leaflet group (P ϭ 0.006), which transferred to a behavioral difference (sitting with lumbar lordosis support) when participants were unaware that they were being observed (P ϭ 0.009). This difference remained significant at 3 months. Patients in the leaflet group also were better at maintaining a wide base of support when lifting a light object than the control subjects throughout all five assessments. There were no significant differences in the functional outcomes tested.Conclusions. This trial demonstrates that written advice for patients can be a contributory factor in the initial general practitioner consultation because it may change aspects of knowledge and behavior. This has implications for the management of acute back pain, with potential health gain.
Doctors can increase satisfaction and moderately improve functional outcomes in the period immediately after the consultation when back pain is worst, by using very simple interventions: either by endorsing a self-management booklet or by giving advice to take exercise. Previous studies suggest that simple advice and the same written information provide reinforcement. This study supports evidence that it may not be helpful to provide a detailed information booklet and advice together, where the amounts or formats of information differ.
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