Low back pain treatment in Australia is not in accordance with international guidelines, a review has concluded.
Low back pain is estimated to be the seventh most common reason for a general practitioner visit in Australia and the fifth most common in the United States, says the review published in the February 8 issue of
Archives of Internal Medicine, one of the JAMA/Archives journals.
An overwhelming body of literature on the management of low back pain -- more than 1,200 published trials and systematic reviews -- makes practice guidelines an efficient way for clinicians to base their care on the best evidence. A previous review concluded that guidelines in 11 countries around the world provide similar recommendations for assessment and management of low back pain.
"Given the proliferation of clinical practice guidelines outlining best practice, it is timely to consider how closely usual care aligns with guideline recommendations," write Christopher M. Williams of The George Institute for International Health, Camperdown, Australia, and colleagues. The authors assessed the care provided for new episodes of low back pain during 3,533 patient visits to general practitioners in Australia between 2001 and 2008. These visits were mapped to key recommendations in treatment guidelines; in addition, data were compared for two three-year periods before and after the release of Australian national guidelines in 2004.
"Our findings show that key aspects of the usual care provided to patients do not align with the care recommended in international evidence-based guidelines," the authors write. For example, although guidelines discourage the use of imaging, more than one-quarter of patients were referred for radiology, computed tomography or similar tests.
