Managing nonspecific low back pain: do nonclinical patient characteristics matter?

Spine (Phila Pa 1976). 2011 Nov 1;36(23):1987-94. doi: 10.1097/BRS.0b013e3181fee8ef.


Study design: A fully blocked experimental design using clinical vignettes to query primary care physicians on prescription for management of acute nonspecific low back pain.

Objective: To identify how nonclinical patient factors, specifically sex, patient presentation, and socioeconomic status, influence physician treatment recommendations for assessing and treating acute nonspecific low back pain.

Summary of background data: Adherence to evidence-based practice guidelines for nonspecific low back pain remains inconsistent. Therefore, it is important to understand what factors guide physician management of these cases.

Methods: One vignette and questionnaire was distributed to primary care and emergency department clinical physicians during meetings at five teaching hospitals. The questionnaire asked for diagnostic and treatment recommendations including specific tests, medications, therapeutic procedures, activity, referral to other services, and patient education for the case represented in the vignette.

Results: Subjects included 284 physicians and approximately 75% had less than 5 years of clinical practice experience. Multivariate logistic regression showed seven significant associations of patient factors with treatment recommendations for acute nonspecific low back pain (one sex, two socioeconomic status, and four patient presentation; P < 0.05).

Conclusion: All three assessed nonclinical factors influenced physician decisions regarding diagnostic and treatment recommendations for acute nonspecific low back pain. Patient presentation, suggestive of a patient's emotional state, was shown to be the most influential.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Pain / diagnosis
  • Acute Pain / therapy
  • Emergency Service, Hospital / statistics & numerical data
  • Evidence-Based Practice / standards
  • Female
  • Guideline Adherence / statistics & numerical data
  • Humans
  • Low Back Pain / diagnosis*
  • Low Back Pain / therapy*
  • Male
  • Outcome Assessment, Health Care / statistics & numerical data
  • Patient Compliance
  • Practice Guidelines as Topic / standards
  • Practice Patterns, Physicians'*
  • Primary Health Care / statistics & numerical data
  • Sex Factors
  • Social Class
  • Surveys and Questionnaires*