TABLE 5.
Results of studies assessing guideline compliance in low back pain (LBP) management – treatments*
| Aspect of care |
Guideline concordant |
Guideline discordant |
|||
|---|---|---|---|---|---|
| Family physician | Physiotherapist | Chiropractor | Family physician | Physiotherapist | |
| Acupuncture | 21% (n=511) (29) | 6% (n=159) (32) | 45% (n=274) (36) | ||
| Bed rest | 90% (n=193) (12), 66% (n=87) (31), 52% with sciatica (n=720) (28); mixed LBP: 74% (n=88) (34) (rest) | 85% (n=255) (12); mixed LBP: 84% (n=66) (34) (rest) | 100% (n=21) (12) | 9% (n=87) (31), 19% (n=511) (29), 7% (n=845) (27), 59% without sciatica (n=720) (28); mixed LBP: 22% (n=88) (34) (rest) | 0.1% (n=274) (36); mixed LBP: 14% (n=66) (34) (rest) |
| ≥3 days | 17% (n=139) (11), 7% without sciatica (n=720) (28), 25% with sciatica (n=720) (28) | ||||
| Epidural steroid injection | 1% without sciatica (n=720) (28), 11% with sciatica (n=720) (28) | ||||
| Exercise | 43% (n=139) (11), 65% (n=511) (29), 65% without sciatica (n=720) (28), 45% with sciatica (n=720) (28) | Mixed LBP: 89% (n=25) (25) | |||
| Heat or ice | 89% (n=87) (31) | 66% heat, 82% ice (n=274) (36) | |||
| Injection therapy | 52% (n=87) (31) | ||||
| Massage therapy | 66% (n=87) (31) | ||||
| Medications | 77% (n=139) (11) | ||||
| Acetaminophen | 72% (n=87) (31), 49% without sciatica (n=720) (28), 46% with sciatica (n=720) (28) | ||||
| Antidepressants | 23% (n=87) (31), 2% without sciatica (n=720) (28), 8% with sciatica (n=720) (28) | ||||
| Muscle relaxants | 83% without sciatica (n=720) (28), 67% with sciatica (n=720) (28) | 91% (n=87) (31) | |||
| NSAIDs | 98% (n=87) (31), 44% (n=511) (29), 93% without sciatica (n=720) (28), 87% with sciatica (n=720) (28) | ||||
| Opioids | 39% without sciatica (n=720) (28), 69% with sciatica (n=720) (28) | 40% (n=139) (11), 62% (n=87) (31) | |||
| Opioids >2 weeks | 1% without sciatica (n=720) (28), 5% with sciatica (n=720) (28) | ||||
| Oral steroids | 45% (n=87) (31), 4% without sciatica (n=720) (28), 24% with sciatica (n=720) (28) | ||||
| Passive physiotherapy | 66% (n=139) (11) (<4 weeks) | 54% (n=139) (11) (>4 weeks) | |||
| Physiotherapy | 57% (n=511) (29), 33% without sciatica (n=720) (28), 55% with sciatica (n=720) (28) | ||||
| Spinal manipulation | 6% (n=139) (11) (<4 weeks), 22% (n=87) (31), 20% (n=166) (32), 28% (n=511) (29), 6% without sciatica (n=720) (28) | 30% (n=274) (36); mixed LBP: 3% (n=25) (25) | 5% (n=139) (11) (>4 weeks), 3% with sciatica (n=720) (28) | ||
| Spinal mobilization | 80% (n=274) (36) | ||||
| Therapeutic ultrasound | 55% (n=87) (31) | 61% (n=274) (36); mixed LBP: 2% (n=25) (25) | |||
| Traction | 55% (n=511) (29) | Mixed LBP: 45% (n=1239) (35) | 2% without sciatica (n=720) (28), 16% with sciatica (n=720) (28) | 36% (n=274) (36); mixed LBP: 41% (n=1239) (35) | |
| Transcutaneous electrical nerve stimulation | 26% (n=511) (29) | 4% without sciatica (n=720) (28), 12% with sciatica (n=720) (28) | 53% (n=274) (36); mixed LBP: 4% (n=25) (25) | ||
| Trigger point injection | 6% without sciatica (n=720) (28), 7% with sciatica (n=720) (28) | ||||
*
Unless stated otherwise, results are for acute/subacute LBP defined as less than 12 weeks’ duration. References for the condition descriptions used in the studies – acute/subacute LBP: 11,12,27–29,31–33,36; mixed LBP (acute or chronic LBP, or described as LBP): 25,26,30,34,35; and chronic LBP: 27,33. Countries: Australia (29); Canada (11,36); France (27); Italy (33); Northern Ireland (25); Norway (12); Sweden (30,34); United Kingdom (26,32,35) and the United States (28,31). NSAIDs Nonsteroidal anti-inflammatory drugs