Guidelines prescribed by general practitioners to patients with acute low back pain regarding “return to work”

Abstract

Background:
The traditional treatment protocol for acute low back pain (ALBP) primarily used by healthcare professionals has in the past decade been strict bed rest, corsets, traction and ‘back schools'. However, current research has led to dramatic changes in the traditional treatment protocol. The literature suggests that the protocol should be replaced by parsimonious imaging, early return to normal activities and greater emphasis on exercise to prevent recurrences of ALBP and to treat chronic pain. The aim of this study was to investigate the guidelines prescribed by general practitioners (GPs) to patients with acute low back pain (ALBP) regarding ‘return to work'.

Methods:
A systematic sample of 212 GPs, selected from a list supplied by the Health Professions Council of South Africa (HPCSA), was selected to complete questionnaires. The highest qualifications of the GPs were MBChB or MFamMed, and all of them practise in the Bloemfontein area.

Results:
Sixty-three respondents stated that 40% of ALBP patients returned for follow-up consultations. Of the 63 respondents, eight GPs had not consulted ALBP patients in the preceding two years, and thus were excluded from the final number of respondents. Bed rest is still prescribed by 67.27% of GPs and, although 47.27% of the GPs were aware of the change in protocol, only 9% prescribe ‘return to work'. A total of 18.18% are aware of evidence-based guidelines and 10% of the GPs prescribe these. Among the guidelines defined by the GPs are lifestyle changes, rest and stabilisation. Only 18.18% of ALBP patients are referred to occupational therapy for treatment.

Conclusion:
Only 47.27% of the GPs knew about the new ALBP protocol, and even fewer had any knowledge of the content of the new protocol. Also, the guidelines prescribed by the GPs concerning ‘return to work' were indefinite. The researchers hypothesised that the reasons for this were a lack of awareness of the change in the acute low back pain protocol suggested by the Agency for Healthcare Research and Quality, as well as a lack of knowledge of the evidence-based guidelines suggested for their profession.


South African Family Practice Vol. 48 (10) 2006: pp. 15-15d