Introduction
Methods
General practitioners
Data collection and analysis
Results
Strongly agree | Mostly agree | Disagree | Strongly disagree | |
---|---|---|---|---|
The guideline is suitable for daily practice | 65 | 35 | ∅ | ∅ |
The guideline increases my confidence in managing low back pain. | 53 | 44 | 3 | ∅ |
I will lose patients by adhering to the guideline | 4 | 17 | 47 | 32 |
I agree with the information provided with the patient leaflet. | 62 | 37 | 1 | ∅ |
The guideline should be disseminated. | 86 | 14 | ∅ | ∅ |
I have been treating low back pain according to the guideline previously. | 39 | 54 | 7 | ∅ |
The guideline has changed my management of low back pain. | 13 | 43 | 34 | 10 |
Triaging patient with low back pain after history taking and physical exam in uncomplicated, radicular and complicated back pain instead of making an anatomical diagnosis is reasonable | 92 | 5 | 3 | ∅ |
The majority of patients in my practice have uncomplicated back pain. | 79 | 17 | 3 | 1 |
The „yellow flags" are useful to recognize patients at risk for chronic back pain. | 54 | 45 | 1 | ∅ |
To postpone imaging for the first 4–6 weeks is reasonable. | 72 | 27 | 1 | ∅ |
The therapeutic options suggested for acute back pain are helpful. | 56 | 43 | 1 | ∅ |
The therapeutic options suggested for chronic back pain are helpful. | 47 | 53 | ∅ | ∅ |
Strongly agree | Mostly agree | Disagree | Strongly disagree | |
---|---|---|---|---|
My patient expect me to clarify the cause of their LBP, otherwise if I postpone diagnostic tests beyond physical examination, I might lose patients. | 12 | 42 | 42 | 4 |
Patient expect extensive diagnostic interventions otherwise the change the physician. | 6 | 39 | 43 | 12 |
Patients expect injection, massage prescriptions or other "new therapies". | 13 | 51 | 31 | 5 |
If I meet patient's expectations in one point (e.g. imaging, injection), I facilitate the promotion of physical activity. | 18 | 49 | 30 | 3 |
Strongly agree | Mostly agree | Disagree | Strongly disagree | |
---|---|---|---|---|
Cooperation with orthopaedic surgeons is good and facilitates guideline adherence. | 7 | 32 | 42 | 19∅ |
Cooperation with neurologist is good and facilitates guideline adherence. | 15 | 53 | 25 | 7 |
Cooperation with physiotherapists is good | 25 | 50 | 19 | 6 |
Cooperation with radiologists is good and facilitates guideline adherence. | 22 | 26 | 29 | 13 |
I have access to multimodal rehabilitation for patients chronic LBP. | 21 | 24 | 25 | 30 |
Topic | Comments of GPs |
---|---|
Guideline in general | ■ Patients need to be taken serious ■ Guideline downplays patients' pain |
Communication | ■ Difficulties conveying the non-biomechanic diagnosis ■ Mentioning the guideline approved by university increases credibility ■ Difficulties "selling" psychotherapy for LBP |
Physical activity | ■ Is easier to promote in younger people ■ Is mainly attractive for women ■ It is hard to motivate elder man ■ It is hard to motivate and give reasons for physical activity to physically hard working patients |
Physiotherapy | ■ Patient are highly satisfied with physical therapy ■ Knowledge deficits about what physical therapist can do ■ Suspicion that PT change prescription for physical therapy into massage |
Imaging | ■ General agreement on its low impact on patient care and therapeutic decisions ■ Patients want imaging ■ Increases prestige of the condition ■ Refusal of imaging could be perceived as cost-saving measure ■ Postponing imaging requires more counselling time |
Cooperation with orthopaedic surgeons | ■ Orthopaedic surgeons are (ab)used to get rid of difficult patients. ■ Fear of being blamed of missing something albeit not important ■ Troubles with access for patients with suspicion of serious complication or severe pain ■ Routine imaging and routine prescription of physiotherapy by orthopaedic surgeons make GPs appear as "poor man's choice" |
Injections | ■ Injections are popular particular among elder patients ■ Replacement of injections with non-steroidals by injections of local anaesthetics |
Patient education | ■ There should be public education on the radio and on tv about the ineffectiveness of bed rest, imaging etc. |