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1.  Physicians' Initial Management of Acute Low Back Pain Versus Evidence-Based Guidelines 
Journal of General Internal Medicine  2005;20(12):1132-1135.
Background
Little information is available on physician characteristics and patient presentations that may influence compliance with evidence-based guidelines for acute low back pain.
Objective
To assess whether physicians' management decisions are consistent with the Agency for Health Research Quality's guideline and whether responses varied with the presentation of sciatica or by physician characteristics.
Design
Cross-sectional study using a mailed survey.
Participants
Participants were randomly selected from internal medicine, family practice, general practice, emergency medicine, and occupational medicine specialties.
Measurements
A questionnaire asked for recommendations for 2 case scenarios, representing patients without and with sciatica, respectively.
Results
Seven hundred and twenty surveys were completed (response rate=25%). In cases 1 (without sciatica) and 2 (with sciatica), 26.9% and 4.3% of physicians fully complied with the guideline, respectively. For each year in practice, the odds of guideline noncompliance increased 1.03 times (95% confidence interval [CI]=1.01 to 1.05) for case 1. With occupational medicine as the referent specialty, general practice had the greatest odds of noncompliance (3.60, 95% CI=1.75 to 7.40) in case 1, followed by internal medicine and emergency medicine. Results for case 2 reflected the influence of sciatica with internal medicine having substantially higher odds (vs case 1) and the greatest odds of noncompliance of any specialty (6.93, 95% CI=1.47 to 32.78), followed by family practice and emergency medicine.
Conclusions
A majority of primary care physicians continue to be noncompliant with evidence-based back pain guidelines. Sciatica dramatically influenced clinical decision-making, increasing the extent of noncompliance, particularly for internal medicine and family practice. Physicians' misunderstanding of sciatica's natural history and belief that more intensive initial management is indicated may be factors underlying the observed influence of sciatica.
doi:10.1111/j.1525-1497.2005.0230.x
PMCID: PMC1490268  PMID: 16423103
back pain; guidelines; practice variation; clinical vignette; decision making

Results 1-1 (1)