This study is the first to assess the low back pain research priorities of primary care practitioners. The top ten priorities identified in this study demonstrate that the primary care practitioners view low back pain within its broad clinical and social context, and suggest that research should be aimed towards developing more effective clinical tools (to classify patients into sub-groups, to identify psychosocial factors, and to treat successfully), and changing knowledge and behaviour of patients (self management and the importance of primary care). For primary care practitioners to successfully manage low back pain and for progress to be made in reducing the burden of the condition, they need answers to these questions.
Generally, clinical guidelines for the management of acute low back pain around the world provide similar recommendations for diagnosis and treatment [1
]. Many also suggest that optimising the uptake of evidence-based guidelines by clinicians and consumers should be a major focus of future research [3
]. In order for this to occur, however, research findings need to be relevant to the practitioners and other consumers. As this is the first study to develop research priorities exclusively from primary care practitioners, the priorities could only be compared to research agendas of published guidelines at a national level. Further studies in other countries are needed to determine whether the similarities and differences found by this comparison occur elsewhere around the world.
A number of similarities can be observed when a comparison is made between the research agenda in the Australian guidelines and the research priorities identified in this study by the primary care practitioners (Table ). The identification of clinical and psychosocial predictors of chronicity, research into the secondary prevention of low back pain, the evaluation of specific physical regimens, and the evaluation of spinal manipulation were nominated as priorities for future research. Some of the priorities in the guidelines which were not identified by the practitioners were not directly relevant to management in primary care, such as the evaluation of multi-disciplinary treatment. Others were for further evaluation of seemingly common interventions such as massage and topical non-steroidal anti-inflammatory drugs (NSAIDs), the effectiveness of which are as yet unclear.
Five out of the top ten priorities identified by the practitioners in this study were not represented in the research agenda of the current Australian guidelines. In our view, the inclusion of these five priorities in research agendas is important to further the understanding and management of low back pain. By developing effective strategies for patients to self-manage their low back pain (priority 4) and gain further understanding of the role of the primary care setting (priority 7) and the professions involved (priority 10), the burden of low back pain on practitioners may be reduced. The presence of these issues within the top ten priorities of the practitioners, but not in the research agenda of the guideline seems anomalous given that guidelines generally recommend that low back pain should be managed in primary care [1
Previous authors [5
] have suggested that the identification of sub-groups of patients (priority 1) be the main priority of future back pain research. Whilst this was also the highest ranked priority of the primary care practitioners in this study, it is not present within the current Australian guideline. The classification of patients into sub-groups based on clinical, psychological, social, or other factors and determining whether they differ in response to treatments is important to ascertain which treatments will be most effective for which patients. Similarly, another priority that was identified by primary care practitioners but was not present in the research agenda of the Australian guidelines was that of diagnosing the cause of low back pain (priority 8). This is an important factor for practitioners and researchers alike, in order to further the understanding of the disease, and provide accurate information to patients regarding their condition and increase effectiveness of treatments. Despite acknowledging that 85% of low back pain cannot be attributed to a specific pathology, the guideline [9
] does not recommend further research to determine the cause of the problem.
The choice of primary care practitioners for this study was based the need for an informed study population who would be able to provide research priorities using their knowledge of current low back pain research. Different priorities may have been raised by other primary care practitioners; however it was thought that any differences between them and the guidelines may simply reflect a lack of awareness of current research. Nevertheless, some of the priorities identified in this study have received a lot of research attention in the past, such as identifying a cause for low back pain. The inclusion of this priority, among others, may be influenced by the lack of consensus among the research community and the demands of patients in the primary care setting.