Physical therapists' clinical knowledge of multidisciplinary low back pain treatment guidelines

• Published in: Physical therapy Vol. 94; no. 7; pp. 934 - 946
• Main Authors: Learman, Kenneth E, Ellis, Alyson R, Goode, Adam P, Showalter, Christopher, Cook, Chad E
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-07-2014
• Subjects: Adult; Ambulatory Care Facilities; Care and treatment; Clinical Competence; Cross-Sectional Studies; Decision Making; Education, Continuing; Female; Health Knowledge, Attitudes, Practice; Humans; Low back pain; Low Back Pain - diagnostic imaging; Low Back Pain - drug therapy; Low Back Pain - therapy; Male; Manipulative therapy; Medical research; Medicine, Experimental; Methods; Motor Activity; Pain; Pain management; Physical therapists; Physical Therapists - education; Physical therapy; Practice; Practice guidelines (Medicine); Practice Guidelines as Topic; Radiography; Referral and Consultation; Sex Factors; United States
• ISSN: 0031-9023; 1538-6724
• DOI: 10.2522/ptj.20130567

Numerous clinical practice guidelines (CPGs) have been developed to assist clinicians in care options for low back pain (LBP). Knowledge of CPGs has been marginal across health-related professions.
The aims of this study were: (1) to measure US-based physical therapists' knowledge of care recommendations associated with multidisciplinary LBP CPGs and (2) to determine which characteristics were associated with more correct responses.
A cross-sectional survey was conducted.
Consenting participants attending manual therapy education seminars read a clinical vignette describing a patient with LBP and were asked clinical decision-making questions regarding care, education, and potential referral. Descriptive statistics illustrating response accuracy and binary logistic regression determined adjusted associations between predictor variables and appropriate decisions.
A total of 1,144 of 3,932 surveys were eligible for analysis. Correct responses were 55.9% for imaging, 54.7% for appropriate medication, 62.0% for advice to stay active, 92.7% for appropriate referral with failed care, and 16.6% for correctly answering all 4 questions. After adjustment, practicing in an outpatient facility was significantly associated with a correct decision on imaging. Female participants were more likely than male participants to correctly select proper medications, refer the patient to another health care professional when appropriate, and answer all 4 questions correctly. Participants reporting caseloads of greater than 50% of patients with LBP were more likely to select proper medications, give advice to stay active, and answer all 4 questions correctly. Participants attending more continuing education were more likely to give advice to stay active and older, and more experienced participants were more likely to appropriately refer after failed care.
There was potential selection bias, which limits generalizability.
The survey identified varied understanding of CPGs when making decisions that were similar in recommendation to the CPGs. No single predictor for correct responses for LBP CPGs was found.