Faculty Collaboration Database

Impact of national low back pain guidelines on clinical practice. South Med J 2005 Feb;98(2):139-43

Date

03/12/2005

Pubmed ID

15759941

DOI

10.1097/01.SMJ.0000136261.21711.85

Scopus ID

2-s2.0-14044254804 (requires institutional sign-in at Scopus site)   30 Citations

Abstract

OBJECTIVES: The purpose of this study was to assess the impact of the 1994 Agency for Health Research and Quality (AHRQ) clinical practice guidelines on the management of acute low back pain.

METHODS: From the National Ambulatory Medical Care Service database, the authors abstracted data on patients being seen in primary care settings, presenting with low back pain as their primary reason for visit, and aged between 20 and 55 years. Patients with an inflammatory or secondary diagnosis to explain their back pain were excluded. Using the sampling weights assigned by the National Ambulatory Medical Care Service, we assessed the medications prescribed, referrals for physiotherapy, and radiography usage for 3 years before (1991 to 1993) and after (1995 to 1997) release of the back pain guidelines.

RESULTS: During these 6 years, more than 10 million ambulatory office visits were available for analysis, 5.2 million visits between 1991 to 1993 and 5.0 million visits between 1995 to 1997. The most common diagnosis was lumbago, present in 21% of these visits. Acetaminophen use increased 20-fold from 0.1 to 2%, nonsteroidal use increased from 40 to 43%, muscle relaxant use decreased from 29 to 20%, radiography ordering increased slightly from 15.4 to 19.4%, and physical therapy referrals declined from 27 to 22%. There was no evidence of a trend toward increased compliance with the AHRQ guidelines over time.

CONCLUSIONS: The AHRQ clinical practice guidelines for the management of acute low back pain had a modest impact on physician behavior, increasing the use of acetaminophen and nonsteroidals and decreasing the use of muscle relaxants and physical therapy referrals.

Author List

Jackson JL, Browning R

Author

Jeffrey L. Jackson MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Disease
Adult
Family Practice
Female
Guideline Adherence
Humans
Low Back Pain
Male
Middle Aged
Practice Guidelines as Topic
Quality of Health Care
United States