GENERAL-PRACTITIONERS MANAGEMENT OF ACUTE BACK PAIN - A SURVEY OF REPORTED PRACTICE COMPARED WITH CLINICAL GUIDELINES

Objective-To compare general practitioners' reported management of acu te back pain with ''evidence based'' guidelines for its management. De sign-Confidential postal questionnaire. Setting-One health district in the South and West region. Subjects-236 general practitioners; 166 (7 0%) responded. Outcome measures-Examination routinely performed, ''dan ger'' symptoms and signs warranting urgent referral, advice given, and satisfaction with management. Results-A minority of general practitio ners do not examine reflexes routinely (27%, 95% confidence interval 2 0% to 34%), and a majority do not examine routinely for muscle weaknes s or sensation. Although most would refer patients with danger signs, some would not seek urgent advice for saddle anaesthesia (6%, 3% to 11 %), extensor plantar response (45%, 37% to 53%), or neurological signs at multiple levels (15%, 10% to 21%). A minority do not give advice a bout back exercises (42%, 34% to 49%), fitness (34%, 26% to 41%), or e veryday activities. A minority performed manipulation (20%) or acupunc ture (6%). One third rated their satisfaction with management of back pain as 4 out of 10 or less. Conclusions-The management of back pain b y general practitioners does not match the guidelines, but there is li ttle evidence from general practice for many of the recommendations, i ncluding routine examination, activity modification, educational advic e, 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 of e vidence.