Original Article

Impact of National Low Back Pain Guidelines on Clinical Practice

Authors: Jeffrey L. Jackson, MD, MPH, Robert Browning, MD

Abstract

Objectives: The purpose of this study was to assess the impact of the 1994 Agency for Health Research and Quality (AHRQ) clinical practice guidelines on the management of acute low back pain.


Methods: From the National Ambulatory Medical Care Service database, the authors abstracted data on patients being seen in primary care settings, presenting with low back pain as their primary reason for visit, and aged between 20 and 55 years. Patients with an inflammatory or secondary diagnosis to explain their back pain were excluded. Using the sampling weights assigned by the National Ambulatory Medical Care Service, we assessed the medications prescribed, referrals for physiotherapy, and radiography usage for 3 years before (1991 to 1993) and after (1995 to 1997) release of the back pain guidelines.


Results: During these 6 years, more than 10 million ambulatory office visits were available for analysis, 5.2 million visits between 1991 to 1993 and 5.0 million visits between 1995 to 1997. The most common diagnosis was lumbago, present in 21% of these visits. Acetaminophen use increased 20-fold from 0.1 to 2%, nonsteroidal use increased from 40 to 43%, muscle relaxant use decreased from 29 to 20%, radiography ordering increased slightly from 15.4 to 19.4%, and physical therapy referrals declined from 27 to 22%. There was no evidence of a trend toward increased compliance with the AHRQ guidelines over time.


Conclusions: The AHRQ clinical practice guidelines for the management of acute low back pain had a modest impact on physician behavior, increasing the use of acetaminophen and nonsteroidals and decreasing the use of muscle relaxants and physical therapy referrals.


Key Points


* Clinical practice guidelines for management of acute low back pain were issued in 1994.


* In the 3 years following release of these guidelines, the use of acetaminophen and nonsteroidal anti-inflammatory drugs increased, while the use of muscle relaxants decreased, as did referrals for physical therapy.


* Agency for Health Research and Quality back pain guidelines had a modest impact on clinical practice.

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