Brief Report: Physicians' initial management of acute low back pain versus evidence-based guidelines. Influence of sciatica

Barbara S. Webster, Theodore K. Courtney, Yueng Hsiang Huang, Simon Matz, David C. Christiani

Research output: Contribution to journalArticlepeer-review

70 Scopus citations


BACKGROUND: Little information is available on physician characteristics and patient presentations that may influence compliance with evidence-based guidelines for acute low back pain. OBJECTIVE: To assess whether physicians' management decisions are consistent with the Agency for Health Research Quality's guideline and whether responses varied with the presentation of sciatica or by physician characteristics. DESIGN: Cross-sectional study using a mailed survey. PARTICIPANTS: Participants were randomly selected from internal medicine, family practice, general practice, emergency medicine, and occupational medicine specialties. Measurements: A questionnaire asked for recommendations for 2 case scenarios, representing patients without and with sciatica, respectively. RESULTS: Seven hundred and twenty surveys were completed (response rate =25%). In cases 1 (without sciatica) and 2 (with sciatica), 26.9% and 4.3% of physicians fully complied with the guideline, respectively. For each year in practice, the odds of guideline noncompliance increased 1.03 times (95% confidence interval [CI] = 1.01 to 1.05) for case 1. With occupational medicine as the referent specialty, general practice had the greatest odds of noncompliance (3.60, 95% CI = 1.75 to 7.40) in case 1, followed by internal medicine and emergency medicine. Results for case 2 reflected the influence of sciatica with internal medicine having substantially higher odds (vs case 1) and the greatest odds of noncompliance of any specialty (6.93, 95% CI = 1.47 to 32.78), followed by family practice and emergency medicine. CONCLUSIONS: A majority of primary care physicians continue to be noncompliant with evidence-based back pain guidelines. Sciatica dramatically influenced clinical decision-making, increasing the extent of noncompliance, particularly for internal medicine and family practice. Physicians' misunderstanding of sciatica's natural history and belief that more intensive initial management is indicated may be factors underlying the observed influence of sciatica.

Original languageEnglish (US)
Pages (from-to)1132-1135
Number of pages4
JournalJournal of general internal medicine
Issue number12
StatePublished - Dec 2005
Externally publishedYes


  • Back pain
  • Clinical vignette
  • Decision making
  • Guidelines
  • Practice variation

ASJC Scopus subject areas

  • Internal Medicine


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