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Physical Therapy Management of Low Back Pain: An Exploratory Survey of Therapist Approaches

LC Li, BSc(PT), MSc, is Research Fellow, Health Care Research Division, Arthritis & Autoimmunity Research Centre, University Health Network, 610 University Ave, 16th Floor, Toronto, Ontario, Canada M5G 2M9 (lli{at}netcom.ca).
C Bombardier, MD, FRCP(C), is Clinical Research Coordinator, Institute for Work & Health; Director, Arthritis & Autoimmunity Research Centre, University Health Network; Professor of Clinical Epidemiology and Director, Heath Care Research Program, Department of Medicine, and Department of Health Administration, University of Toronto; and Staff Physician, Department of Medicine, Mt Sinai Hospital, Toronto, Ontario, Canada

Address all correspondence to Ms Li

Background and Purpose. Since the release of acute low back pain management guidelines in 1994, little was known about the effect of these guidelines on clinical practice. The purpose of this study was to examine physical therapists' reported management of acute and subacute lumbar impairment. Subjects. One in 10 registered physical therapists who were randomly selected from southern Ontario, Canada, (n=454) and all registered physical therapists from northern Ontario (n=331) were surveyed. Methods. In the questionnaire, case scenarios covered 3 areas related to the management of lumbar impairment: (1) physical examination, (2) treatment and recommendations, and (3) therapists' beliefs regarding its management. Results. Five hundred sixty-nine questionnaires were returned (response rate=72.5%). Only data obtained for therapists (n=274) whose weekly workload included more than 10% of people with lumbar impairment were used in the analysis. Overall, patient education, exercise, and electrotherapeutic and thermal modalities were the preferred interventions for acute lumbar impairment (symptom onset of less than 5 weeks) with or without sciatica, whereas exercise and work modification were preferred for subacute lumbar impairment (symptom onset of 5 weeks or longer). There was a trend of using electrotherapeutic and thermal modalities of uncertain effectiveness. Only 46.3% of the therapists agreed or strongly agreed that practice guidelines were useful for managing lumbar impairment. Discussion and Conclusion. Although the physical therapists surveyed, in general, followed the guidelines in managing acute lumbar impairment, they felt uncertain regarding the value of practice guidelines. Future research should focus on identifying effective treatment approaches and exploring the effectiveness of practice guidelines.

Key Words: Back • Low back pain • Practice pattern • Survey

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