Implementation of RCGP guidelines for acute low back pain: a cluster randomised controlled trial. Doctors With a Special Interest in Back Pain Have Poorer Knowledge About How to Treat Back Pain 2001 Volvo Award Winner in Clinical Studies: Effects of a Media Campaign on Back Pain Beliefs and Its Potential Influence on Management of Low Back Pain in General Practice Does physiotherapy management of low back pain change as a result of an evidence-based educational programme? Implementation of the Dutch Low Back Pain Guideline for General Practitioners: A Cluster Randomized Controlled Trial IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT): Cluster randomised controlled trial study protocol Randomized controlled trial of education and feedback for implementation of guidelines for acute low back pain Health locus of control beliefs and psychological distress as predictors for treatment outcome in low-back pain patients: results of a 3-month follow-up of a controlled intervention study Enhanced implementation of low back pain guidelines in general practice: study protocol of a cluster randomised controlled trial Routine primary care management of acute low back pain: adherence to clinical guidelines A back school in The Netherlands: evaluating the results. A systematic review of workplace interventions to prevent low back pain. Psychosocial Factors in the Workplace‐Do They Predict New Episodes of Low Back Pain?: Evidence From the South Manchester Back Pain Study Should treatment of (sub)acute low back pain be aimed at psychosocial prognostic factors? Cluster randomised clinical trial in general practice Low back pain in general practice: reported management and reasons for not adhering to the guidelines in The Netherlands. How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapists Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care.
BACKGROUND The Royal College of General Practitioners ( RCGP ) has produced guidelines for the management of acute low back pain in primary care . AIM To investigate the impact on patient management of an educational strategy to promote these guidelines among general practitioners ( GPs ) . DESIGN OF STUDY Group r and omised controlled trial , using the health centre as the unit of r and omisation . SETTING Primary care teams in north-west Engl and . METHOD Twenty-four health centres were r and omly allocated to an intervention or control arm . Practice s in the intervention arm were offered outreach visits to promote national guidelines on acute low back pain , as well as access to fast-track physiotherapy and to a triage service for patients with persistent symptoms . RESULTS Twenty-four centres were r and omised . Two thous and , one hundred and eighty-seven eligible patients presented with acute low back pain during the study period : 1049 in the intervention group and 1138 in the control group . There were no significant differences between study groups in the proportion of patients who were referred for X-ray , issued with a sickness certificate , prescribed opioids or muscle relaxants , or who were referred to secondary care , but significantly more patients in the intervention group were referred to physiotherapy or the back pain unit ( difference in proportion = 12.2 % , 95 % confidence interval [ CI ] = 2.8 % to 21.6 % ) . CONCLUSION The management of patients presenting with low back pain to primary care was mostly unchanged by an outreach educational strategy to promote greater adherence to RCGP guidelines among GPs . An increase in referral to physiotherapy or educational programmes followed the provision of a triage service Study Design . We conducted an observational study using mailed question naires to 3 r and om sample s of general practitioners from Victoria and New South Wales , Australia in 1997 , 2000 , and 2004 . Objective . To determine whether general practitioners ’ beliefs about low back pain ( LBP ) differ according to whether they have a special interest in back pain , musculoskeletal , or occupational medicine ; and whether these beliefs are modified by having had continuing medical education ( CME ) about back pain in the previous 2 years . Summary of Background Data . Physician surveys continue to demonstrate that general practitioners only partially manage LBP in an evidence -based way . Identified barriers to changing physician behavior , in regard to management of back pain , have included patient factors such as their past back pain experiences and preferences for care as well as physician beliefs about the association of pain and activity ; although the influence of physician special interests has not been studied . Methods . Back pain beliefs of different subsets ( special interests vs. no special interests and CME vs. no CME ) were compared using relative risks ( RRs ) adjusted for state and survey . The analysis was then repeated including all special interests and recent back pain CME in the model . Results . Responses were received from 3831 general practitioners ( overall response rate [ RR ] : 38.2 % ) . Physicians with a special interest in LBP were more likely to believe that complete bed rest and avoidance of work is appropriate for acute low back pain ( RR : 1.89 [ 95 % CI : 1.53–2.33 ] and 1.55 [ 95 % CI : 1.31–1.83 ] , respectively ) and lumbar spine radiographs are useful ( RR : 1.36 [ 95 % CI : 1.21–1.51 ] ) . The disparity between those with and without a special interest in LBP was still evident after adjusting for the presence of other special interests and recent CME . After adjusting for the presence of other special interests and recent CME , therewere no important differences in back pain beliefs between those with and without a special interest in musculoskeletal medicine , while those with a special interest in occupational medicine and those who had received recent CME had better beliefs . Conclusion . A special interest in back pain is associated with back pain management beliefs contrary to the best available evidence . This has serious implication s for management of back pain in the community Study Design . Quasi-experimental , nonr and omized , nonequivalent , parallel group-controlled study involving before and after telephone surveys of the general population and postal surveys of general practitioners was conducted , with an adjacent state used as a control group . Objectives . To evaluate the effectiveness of a population -based intervention design ed to alter beliefs about back pain , influence medical management , and reduce disability and workers ’ compensation – related costs . Summary of Background Data . A multimedia campaign begun during 1997 in Victoria , Australia , positively advised patients with back pain to stay active and exercise , not to rest for prolonged periods , and to remain at work . Methods . The campaign ’s impact on population beliefs about back pain and fear-avoidance beliefs was measured in telephone surveys , and the effect of the campaign on the potential management of low back pain by general practitioners was assessed by eliciting their likely approach to two hypothetical scenarios in mailed surveys . Demographically identical population groups in Victoria and the control state , New South Wales , were surveyed at three times : before , during , and after intervention in Victoria . Results . The studies were completed by 4730 individuals in the general population and 2556 general practitioners . There were large statistically significant improvements in back pain beliefs over time in Victoria ( mean scores on the Back Beliefs Question naire , 26.5 , 28.4 , and 29.7 ) , but not in New South Wales ( 26.3 , 26.2 , and 26.3 , respectively ) . Among those who reported back pain during the previous year , fear-avoidance beliefs about physical activity improved significantly in Victoria ( mean scores on the Fear-Avoidance Beliefs Question naire for physical activity , 14 , 12.5 , and 11.6 ) , but not in New South Wales ( 13.3 , 13.6 , and 12.7 , respectively ) . General practitioners in Victoria reported significant improvements over time in beliefs about back pain management , as compared with their interstate colleagues . There were statistically significant interactions between state and time for 7 of 10 responses on management of acute low back pain , and for 6 of 10 responses on management of subacute low back pain . Conclusion . A population -based strategy of providing positive messages about back pain improves the beliefs of the general population and general practitioners about back pain and appears to influence medical management RATIONALE The concept of evidence -based medicine is important in providing efficient health care . The process uses research findings as the basis for clinical decision making . Evidence -based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide . Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence . The use of opinion leaders to disseminate new evidence around the management of low back pain into practice has been proposed . AIMS The aim of this study was to investigate if physiotherapists ' clinical management of patients with low back pain would change following an evidence -based education package , which utilized local opinion leaders and delivered the best evidence . METHOD Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster r and omized by location of work , to two groups . The intervention group received an evidence -based programme on the management of low back pain , including advice regarding increasing activity levels and return to normal activity and challenging patients ' fears and beliefs about their pain . The control group received a st and ard in-service training package on the management of common knee pathologies . The physiotherapists ' clinical management of patients with low back pain was measured prior to training and 6 months post training . Outcome measures were based on physiotherapists completing ' discharge summary ' question naires , which included information relating to the use and importance of therapies for treating their low back pain patients . RESULTS There were few significant differences in treatment options between the intervention and control groups post training . Whilst there was some indication that physiotherapists were already utilizing aspects of psychosocial management for patients with low back pain , there was little change in what physiotherapists perceived to be important to patient recovery and actual clinical practice following the intervention . CONCLUSIONS Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain . This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice . Whilst there were some limitations in the overall size of the study , the results help to give an insight into the challenges faced by the health care system and research ers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care Study Design . Cluster r and omized controlled trial for a multifaceted implementation strategy . Objectives . To assess the effectiveness of tailored  interventions ( multifaceted implementation strategy ) to implement the  Dutch low back pain guideline for general practitioners with regard to adherence to guideline recommendations . Summary of Background Data . Guidelines for the management of low back pain in primary care have been developed in various countries , but little is known about the optimal implementation strategy . A multifaceted implementation strategy was developed to overcome identified barriers to the implementation of the Dutch low back pain guideline for general practitioners . Methods . General practitioners were r and omized to an intervention or a control group . The general practitioners in the intervention group ( n = 21 ) received tailored interventions consisting of the Dutch low back pain guideline for general practitioners , a 2-hour educational and clinical practice workshop ; two scientific articles on low back pain management ; the guideline for occupational physicians ; a tool for patient education ; and a tool for reaching agreement on low back care with physical , exercise , and manual therapists . The control group ( n = 20 ) received no intervention . The participating general practitioners were asked to recruit consecutive patients with a new episode of low back pain as the main reason for consultation . General practitioners completed registration forms of each individual consultation with regard to the main outcome measures : advice and information , referral to other health-care providers , and prescription of medication . Results . Forty-one of the 67 r and omized general practitioners reported on a total of 616 consultations for 531 patients with nonspecific low back pain . The advice and explanation provided by the general practitioners , the prescription of paracetamol or nonsteroidal anti-inflammatory drugs , and prescription of pain medication on atime contingent or a pain contingent basis showed no statistically significant differences between the intervention and control groups . There were also no differences in overall referral rate . However , in follow-up consultations fewer patients were referred to a physical or exercise therapist by the general practitioners in the intervention group than in the control group . Conclusions . The multifaceted intervention strategy modestly improved implementation ( for parts of the recommendations in ) the Dutch low back pain guideline by general practitioners and produced small concomitant changes in patient management . The implementation strategy produced fewer referrals to therapists during follow-up consultations Background Evidence generated from reliable research is not frequently implemented into clinical practice . Evidence -based clinical practice guidelines are a potential vehicle to achieve this . A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines . Recommendations from this review , and other studies , have suggested the use of interventions that are theoretically based because these may be more effective than those that are not . An evidence -based clinical practice guideline for the management of acute low back pain was recently developed in Australia . This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common , has a high burden , and for which there is an evidence - practice gap in the primary care setting . Aim This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria , Australia . Specifically , our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray  , and improving mean level of disability for patients three months post-consultation . Methods / Design This study protocol describes the details of a cluster r and omised controlled trial . Ninety-two general practice s ( clusters ) , which include at least one consenting general practitioner , will be r and omised to an intervention or control arm using restricted r and omisation . Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion . An average of twenty-five patients per general practice will be recruited , providing a total of 2,300 patient participants . General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy . Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory . Investigators ( not involved in the delivery of the intervention ) , patients , outcome assessors and the study statistician will be blinded to group allocation . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN012606000098538 ( date registered 14/03/2006 ) OBJECTIVE : The effect of clinical guidelines on re source utilization for complex conditions with substantial barriers to clinician behavior change has not been well studied . We report the impact of a multifaceted guideline implementation intervention on primary care clinician utilization of radiologic and specialty services for the care of acute low back pain . DESIGN : Physician groups were r and omized to receive guideline education and individual feedback , supporting patient education material s , both , or neither . The impact on guideline adherence and re source utilization was evaluated during the 12-month period before and after implementation . PARTICIPANTS : Fourteen physician groups with 120 primary care physician and associate practitioners from 2 group model HMO practice s. INTERVENTIONS : Guideline implementation utilized an education/audit/feedback model with local peer opinion leaders . The patient education component included written and videotaped material s on the care of low back pain . MAIN RESULTS : The clinician intervention was associated with an absolute increase in guideline -consistent behavior of 5.4 % in the intervention group versus a decline of 2.7 % in the control group ( P=.04 ) . The patient education intervention produced no significant change in guideline -consistent behavior , but was poorly adopted . Patient characteristics including duration of pain , prior history of low back pain , and number of visits during the illness episode were strong predictors of service utilization and guideline -consistent behavior . CONCLUSIONS : Implementation of an education and feedback-supported acute low back pain care guideline for primary care clinicians was associated with an increase in guideline -consistent behavior . Patient education material s did not enhance guideline effectiveness . Implementation barriers could limit the utility of this approach in usual care setting & NA ; Association of health locus of control beliefs ( HLC ) and psychological distress ( GHQ‐12 ) with short‐term outcome of low‐back pain ( LBP ) rehabilitation was studied in patients with chronic or recurrent LBP ( n = 459 ; aged 35–54 years ; 63 % men ) . These patients were r and omly assigned to 3 study groups , namely the inpatient , the outpatient and the control group . The results showed a significant decrease in disability due to LBP in the 2 treated groups ; in addition , the accomplishment and frequency of back exercises was significantly better in the treated groups . HLC beliefs were associated with a successful outcome ; those patients with stronger internal beliefs had gained more from the treatment , had learned their exercises better and had done the exercises more frequently during the follow‐up period . Symptoms of psychological distress were significantly associated with poorer accomplishment of back exercises Background Evidence -based clinical practice guidelines may improve treatment quality , but the uptake of guideline recommendations is often incomplete and slow . Recently new low back pain guidelines are being launched in Denmark . The guidelines are considered to reduce personal and public costs . The aim of this study is to evaluate whether a complex , multifaceted implementation strategy of the low back pain guidelines will reduce secondary care referral and improve patient outcomes compared to the usual simple implementation strategy . Methods / design In a two-armed cluster r and omised trial , 100 general practice s ( clusters ) and 2,700 patients aged 18 to 65 years from the North Denmark region will be included . Practice s are r and omly allocated 1:1 to a simple or a complex implementation strategy . Intervention practice s will receive a complex implementation strategy , including guideline facilitator visits , stratification tools , and quality reports on low back pain treatment . Primary outcome is referral to secondary care . Secondary outcomes are pain , physical function , health-related quality of life , patient satisfaction with care and treatment outcome , employment status , and sick leave . Primary and secondary outcomes pertain to the patient level . Assessment s of outcomes are blinded and follow the intention-to-treat principle . Additionally , a process assessment will evaluate the degree to which the intervention elements will be delivered as planned , as well as measure changes in beliefs and behaviours among general practitioners and patients . Discussion This study provides knowledge concerning the process and effect of an intervention to implement low back pain guidelines in general practice , and will provide insight on essential elements to include in future implementation strategies in general practice .Trial registration Registered as NCT01699256 on Clinical Trials.gov One of the major challenges for general practitioners is to manage individuals with acute low back pain appropriately to reduce the risk of chronicity . A prospect i ve study was design ed to assess the actual management of acute low back pain in one primary care setting and to determine whether existing practice patterns conform to published guidelines . Twenty-four family physicians from public primary care centers of the Basque Health Service in Bizkaia , Basque Country ( Spain ) , participated in the study . A total of 105 patients aged 18–65 years presenting with acute low back pain over a 6-month period were included . Immediately after consultation , a research assistant performed a structured clinical interview . The patients ’ care provided by the general practitioner was compared with the Agency for Health Care Policy and Research ( AHCPR ) guidelines and guidelines issued by the Royal College of General Practitioners . The diagnostic process showed a low rate of appropriate use of history ( 27 % ) , physical examination ( 32 % ) , lumbar radiographs ( 31 % ) , and referral to specialized care ( 33 % ) . Although the therapeutic process showed a relatively high rate of appropriateness in earlier mobilization ( 77 % ) and educational advice ( 65 % ) , only 23 % of patients were taught about the benign course of back pain . The study revealed that management of acute low back pain in the primary care setting is far from being in conformance with published clinical guidelines The use of an education program for patients with chronic low back pain ( Back School ) has been investigated . The effect evaluation is based on a pretest-post-test-control group design , including a follow-up after 8 weeks . The Maastricht Back School is based on the theory that pain is also maintained by emotional , cognitive and environmental factors . Information and training are given on these and physical factors . The purpose of the course is to teach patients to manage their own pain problem . The results suggest that the Back School program for patients with chronic low back pain can have a positive effect A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of  workplace interventions  to prevent low back pain .  Potential trials were located by a computerised search supplemented with citation tracking . The method ological quality of the trials was assessed on 11 criteria and the level of evidence for each intervention was determined , based upon the amount , consistency and quality of evidence from the trials . The review located 13 trials that were generally of moderate quality . The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain Study Design . A prospect i ve , population ‐based cohort study of working adults . Objectives . To determine whether work‐related psychosocial factors and social status predict the occurrence of new episodes of low back pain and influence consultation behavior . Summary and Background Data . Dissatisfaction with work and social status has been associated with low back pain in several studies ; few of these studies have been prospect i ve or population based . Methods . An initial postal survey  was returned by 4,501 ( 59 % ) adults ( 18‐75 years old ) registered with two primary care practice s. From this , a cohort of 1,412 people currently in employment and free of low back pain was identified , and baseline information on work‐related psychosocial factors and psychologic distress was obtained . Social class was derived from current occupation using a st and ardized classification . New episodes of low back pain occurring in the next 12 months were identified by continuous monitoring of primary care consulters and by mailing a second question naire a year later to identify occurrences of low back pain for which no consultation was sought . Results . The baseline cross‐sectional survey showed modest but significant associations between low back pain and perceived inadequacy of income ( risk ratio 1.3 ) , dissatisfaction with work ( risk ratio 1.4 ) and social class IV/V ( risk ratio 1.2 ) . In the follow‐up year , the risk of reporting low back pain for which no consultation was sought doubled in those dissatisfied with their work . Both perceived inadequacy of income ( odds ratio 3.6 ) and social class IV/V ( odds ratio 4.8 ) were strongly associated with consulting with a new episode of low back pain during the follow‐up year , an association more marked in women . The associations with work dissatisfaction and perceived adequacy of income were not explained by general psychologic distress or social status . Conclusion . People dissatisfied with work are more likely to report low back pain for which they do not consult a physician , whereas lower social status and perceived inadequacy of income are independent risks for working people to seek consultation because of low back pain Abstract Objective To compare the effects of a minimal intervention strategy aim ed at assessment and modification of psychosocial prognostic factors and usual care for treatment of (sub)acute low back pain in general practice . Design Cluster r and omised clinical trial . Setting 60 general practitioners in 41 general practice s. Participants 314 patients with non-specific low back pain of less than 12 weeks ' duration , recruited by their general practitioner . Interventions In the minimal intervention strategy group the general practitioner explored the presence of psychosocial prognostic factors , discussed these factors , set specific goals for reactivation , and provided an educational booklet . The consultation took about 20 minutes . Usual care was not st and ardised . Main outcome measures Functional disability ( Rol and -Morris disability question naire ) , perceived recovery , and sick leave because of low back pain assessed at baseline and after 6 , 13 , 26 , and 52 weeks . Results The dropout rate was 8 % in the minimal intervention strategy group and 9 % in the usual care group . Multilevel analyses showed no significant differences between the groups on any outcome measure during 12 months of follow-up in the whole group or in relevant subgroups ( patients with high scores on psychosocial measures at baseline or a history of frequent or prolonged low back pain ) . Conclusion This study provides no evidence that ( Dutch ) general practitioners should adopt our new treatment strategy aim ed at psychosocial prognostic factors in patients with (sub)acute low back pain . Further research should examine why our new strategy was not more effective than usual care BACKGROUND Although guidelines for the management of low back pain have been published in the past decade , there is potential for further improvement in back pain care . AIM To document the management of non-specific low back pain by general practitioners ( GPs ) in the Netherl and s , to determine how this management of care is related to patient and physician factors , and to explore possible reasons for not adhering to the guidelines . METHOD A prospect i ve study was set up in which 57 GPs in 30 general practice s completed a computerised question naire after each consultation for low back pain during a four-month period . RESULTS Of 1640 back pain contacts , 1180 referred to non-specific low back pain . Diagnostic tests were ordered in 2 % of first consultations and in 7 % of follow-up consultations within one episode . The advice to  stay active  despite  pain  was given in 76 % and 69 % of these cases respectively . Patients were prescribed an  analgesic  in 53 % and 41 % of cases respectively ( mainly NSAIDs [ 80 % ] ) . Patients were referred to a physiotherapist in 22 % of first and in 50 % of follow-up consultations . Older patients were physically examined less often , prescribed analgesics more often , and were told less often that staying active could benefit them . The advice to remain active was omitted more often when symptoms lasted longer . Only a small part of the variance in management was accounted for by patient characteristics or by differences between practice s. CONCLUSION The management of low back pain met the guidelines to a large extent . Management decisions were often related to characteristics in which the guidelines lack differentiation . Important reasons for non-adherence were perceived patients ' preferences . Further implementation of guidelines will be difficult unless doctors ' and patients ' views are more explicitly known & NA ; Guidelines for the management of low back pain ( LBP ) have existed for many years , but adherence to these by health care practitioners ( HCPs ) remains suboptimal . The aim of this study was to measure the attitudes , beliefs and reported clinical behaviour of UK physiotherapists ( PTs ) and general practitioners ( GPs ) about LBP and to explore the associations between these . A cross‐sectional postal survey of GPs ( n = 2000 ) and PTs ( n = 2000 ) was conducted that included the  Pain Attitudes and Beliefs Scale ( PABT.PT )  , and a vignette of a  patient with non‐specific LBP ( NSLBP )  with questions asking about recommendations for work , activity and bedrest . Data from 1022 respondents ( 442 GPs and 580 PTs ) who had recently treated patients with LBP were analysed . Although the majority of HCPs reported providing advice for the vignette patient that was broadly in line with guideline recommendations , 28 % reported they would advise this patient to remain off work . Work advice was significantly related to the PABS.PT scores with higher biomedical ( F1,986 = 77.5 , p < 0.0001 ) and lower behavioural ( F1,981 = 31.9 , p < 0.001 ) scores associated with advice to remain off work . We have demonstrated that the attitudes and reported practice behaviour of UK GPs and PTs for patients with NSLBP are diverse . Many HCPs held the belief that LBP necessitates some avoidance of activities and work . The attitudes and beliefs of these HCPs were associated with their self‐reported clinical behaviour regarding advice about work . Future studies need to investigate whether approaches aim ed at modifying these HCP factors can lead to improved patient outcomes STUDY DESIGN A double-blind , r and omized controlled trial of a novel educational booklet compared with a traditional booklet for patients seeking treatment in primary care for acute or recurrent low back pain . OBJECTIVE To test the impact of a novel educational booklet on patients ' beliefs about back pain and functional outcome . SUMMARY OF BACKGROUND DATA The information and advice that health professionals give to patients may be important in health care intervention , but there is little scientific evidence of their effectiveness . A novel patient educational booklet , The Back Book , has been developed to provide evidence -based information and advice consistent with current clinical guidelines . METHODS One hundred sixty-two patients were given either the experimental booklet or a traditional booklet . The main outcomes studied were fear-avoidance beliefs about physical activity , beliefs about the inevitable consequences of back trouble , the Rol and Disability Question naire , and visual analogue pain scales . Postal follow-up response at 1 year after initial treatment was 78 % . RESULTS Patients receiving the experimental booklet showed a statistically significant greater early improvement in beliefs which was maintained at 1 year . A greater proportion of patients with an initially high fear-avoidance beliefs score who received the experimental booklet had clinical ly important improvement in fear-avoidance beliefs about physical activity at 2 weeks , followed by a clinical ly important improvement in the Rol and Disability Question naire score at 3 months . There was no effect on pain . CONCLUSION This trial shows that carefully selected and presented information and advice about back pain can have a positive effect on patients ' beliefs and clinical outcomes , and suggests that a study of clinical ly important effects in individual patients may provide further insights into the management of low back pain
Themes that emerged included doctors ' attitudes and beliefs , and four factors that influenced attitudes and beliefs : doctors ' specialty , demographic factors , personal beliefs and education .
There was consistent evidence that doctors ' specialty impacted their attitudes and beliefs : lack of consensus regarding the natural history of LBP , around treatment options , and issues regarding work .
There was inconsistent evidence that demographic factors ( age ) and level of education impacted doctors ' attitudes and beliefs .
Long term , these changes in these areas have the potential to maximise patient-care , and reduce costs to health services
The aim of this systematic review was to determine the attitudes and beliefs of doctors to acute low back pain , and the factors that influence these .