Do Italian Physiotherapists Follow Evidence-Based Guidelines When Managing Patients With Low Back Pain? A Cross-Sectional Survey

Abstract

INTRODUCTION: Guideline-recommended management of low back pain (LBP) is associated with improved patient outcomes and costs. This study aimed to assess Italian physiotherapists' attitudes towards and adherence to LBP clinical practice guidelines (CPGs). METHODS: We conducted an online cross-sectional survey of Italian physiotherapists. Participants' demographics, attitudes towards, and familiarity with CPGs were collected. Six vignettes of patients with LBP were presented. For each, participants selected management options from a pre-specified list. Management options were categorised as recommended, not recommended, and no recommendation based on CPG recommendations and systematic reviews. Ordinal logistic regression assessed associations between participant characteristics and the number of vignettes for which recommended and not recommended care options were selected (stratified by non-specific LBP and red flag vignettes). RESULTS: Of the 272 participants completing the demographic section of the survey, 142 completed all vignettes. Care that was recommended, not recommended, and had no recommendation was selected by 87%, 32%, and 93% of participants on average in the six vignettes, respectively. Working in a hospital setting was associated with a reduced likelihood of selecting recommended care for non-specific LBP (coefficient: -1.28; 95% CI: -2.20, -0.36). Stronger self-reported familiarity with three published CPGs was associated with decreased likelihood of selecting not recommended care but was not associated with selecting recommended care for non-specific LBP. All other variables were not associated with selecting recommended and not recommended care. CONCLUSIONS: Physiotherapists commonly selected recommended care options for patients with LBP, yet there remains considerable scope to reduce selection of care which is not recommended.