Exploration of physicians' recommendations for activities in chronic low back pain

Study Design. A mailed survey of 142 practicing physicians (63 orthopedic s pine surgeons and 79 family physicians) inquiring about their expertise and experience with chronic low back pain, their pain attitudes and beliefs, a nd recommendations about the appropriate level of function for chronic back pain patients. Objectives. To explore physicians' recommendations for activity and work fo r patients with chronic low back pain and to determine factors that might i nfluence these recommendations. Summary of Background Data. Physicians continuously are asked to recommend the appropriate level of activities and work for patients with chronic low back pain. Although these recommendations can have a significant impact on patients' lives, little is known about the factors that shape recommendatio ns. Methods. Mailed surveys included questions inquiring about the physicians' demographics, training, and experience in low back pain, the Health Care Pr oviders' Pain and Impairment Relationship Scale, and three vignettes of wor k-disabled, chronic low back pain patients. After each vignette, physicians rated their perceptions of severity of symptoms and pathology and recommen dations for work and daily activities through five graded responses. Three mailings were done with in 4 weeks to maximize the response rate. The assoc iation of each variable with work and activity recommendations was statisti cally explored. To assess the influence of clinical expertise on recommenda tions, the responses of orthopedic spine surgeons were compared with those of family physicians. Test-retest reliability was assessed with a second ma iling of the questionnaire to all initial responders. Results. Sixty-five percent of the orthopedic surgeons and 52% of the famil y physicians responded to the survey. Thirty-nine percent of the initial re sponders completed the reliability survey. The survey instrument demonstrat ed modest reliability, with identical recommendations for activities and wo rk occurring 57% of the time. In general, a wide range of activities and wo rk was recommended, with most physicians recommending avoidance of painful activities or greater restrictions. Orthopedic spine surgeons were slightly less restrictive in their activity recommendations compared with family ph ysicians. Most physicians demonstrated some consistency in their pattern of recommendations when compared with their colleagues. Physicians' pain atti tudes and belief influenced their recommendations, as did their perception of the severity of the patients' clinical symptoms. Conclusions. Physicians' recommendations for activity and work to patients with chronic back pain vary widely and frequently are restrictive. These re commendations reflect personal attitudes of the physicians as well as facto rs related to the patients' clinical symptoms.