Management of Low Back Pain in Primary Health-Care Settings: Physician’s Awareness and Practices Based on Red Flags

Abstract

Background: Low back pain (LBP) is one of the most common health problems. Red flags (RFs) of LBP are risk factors that are reported during clinical assessment to determine serious illness. This study aimed to assess primary health-care physicians' knowledge of and practices for RFs of LBP and identify variables associated with a high level of knowledge and awareness about it. Methods: An observational cross-sectional survey was conducted in 2021 among a random sample of 261 primary health care (PHC) physicians in the Jazan Region in southwest Saudi Arabia. A web-based questionnaire was used to collect data on LBP red flags awareness and practices. Descriptive (frequency and percentage) and inferential statistics were used for data analysis. Results:The overall mean score of RFs knowledge among physicians was 82.33 ± 36.3, with 95% confidence interval (CI); (77.7-86.9). Regarding the Physician's practices, more than 95% of the participants would refer patients to higher levels in the presence of symptoms or signs of RFs. General practitioners and residents were significantly more likely to ask for an Xray, even with symptoms that had persisted for less than 2 weeks without RF signs (p = 0.006). The overall percentage of patients with nonspecific LBP referrals was as high as 57.8%. The number of patients with LBP seen per month (fewer than 15) and female physician were associated with an increased level of knowledge (OR = 2.2, 95%, P < 0.05) and (OR = 2.2, 95%, P < 0.05) respectively. Conclusion: Overall, awareness of RFs for LBP and referring critical patients who present with LBP is good among PHC physicians in the Jazan Region. Junior physicians have a low threshold to request images. The referral rate for nonspecific LBP is still high, which could overwhelm spinal clinics. Further educational programs for back pain management are recommended.

Factors influencing imaging clinical decision‐making in low back pain management. A scoping review

“…Fifteen studies ( n = 15) reported that clinician characteristics influence imaging CDM (Arishy et al., 2022; Barnett et al., 2020; Bouck et al., 2019; Bussières et al., 2013; de Zoete et al., 2022; Dietrich et al., 2018; Ganesh et al., 2022; Gidwani et al., 2016; Graves et al., 2012; Hong et al., 2017; Le et al., 2018; Learman et al., 2014; Sears et al., 2016; Tan et al., 2016; Zargar et al., 2014). Clinician characteristics were divided into six subcategories: age ( n = 1; 7%) sex ( n = 1; 7%), experience (years) ( n = 5; 33%), education ( n = 4; 27%), role ( n = 8; 53%) and clinical practice ( n = 6; 40%) (Table 3).…”

“…(Not) having prior treatment or imaging (Zargar et al, 2014). Logistics: Time arrived and duration spent at clinic (Ferreira et al, 2019), prevalence of observation/treatment room use (Schlemmer et al, 2015), year of appointment (Barnett et al, 2020) Clinician characteristics Age Age (Barnett et al, 2020) Sex Sex (Bussières et al, 2013) Experience (years) Years (Bussières et al, 2013;de Zoete et al, 2022;Learman et al, 2014;Sears et al, 2016;Tan et al, 2016) Education Level of qualification (de Zoete et al, 2022;Ganesh et al, 2022), school (Bussières et al, 2013) or country (Tan et al, 2016) in which qualification was obtained Role Title/discipline (Arishy et al, 2022;Barnett et al, 2020;Bouck et al, 2019;Dietrich et al, 2018;Gidwani et al, 2016;Graves et al, 2012;Tan et al, 2016;Zargar et al, 2014),…”

Echocardiographic evaluation of myocardial strain in bipolar disorder across different phases: A comparative study with healthy controls

“…Research in this area has focused predominantly on the broader aspects of cardiovascular risk, such as the prevalence of traditional risk factors such as hypertension, diabetes, and dyslipidemia in individuals with bipolar disorder. [ 3 ] There has been less emphasis on the direct assessment of cardiac function using advanced techniques such as echocardiography, particularly in terms of myocardial strain. Myocardial deformation, a parameter that provides information on cardiac muscle deformation during the cardiac cycle, is an important indicator of myocardial function and has been associated with various cardiac pathologies.…”