Low back pain - a community-based study of care-seeking and therapeutic effectiveness

Purpose: To describe care seeking characteristics among low back pain subjects (LBP); to describe the perceived effectiveness of interventions by recipients of care for LBP; and to discuss the gap between LBP management guidelines and actual practice in primary care. Methods: The population consisted of 555 subjects who were recruited from a cross sectional survey of all inhabitants of a small town in Israel. They reported 1 month LBP and were further probed regarding the characteristics of their pain and pattern of care. Data collection was performed by a self-administered questionnaire. Results: Some form of care was sought by 78.7% of the participants. More than half (58%) visited a physician, 34.4% were prescribed drug therapy, 37.1% attended physical therapy and 28.6% turned to alternative medicine. Participants with severe pain were more likely to seek care. That was demonstrated by all pain measures (e.g. high Roland and Morris disability scores (8.2 +/- 5.6 vs 4.4 +/- 4.1), high symptoms frequency (8.9 +/- 4.1 vs 7.5 +/- 3.6) and high pain severity scores (5.6 +/- 2.2 vs 4.5 +/- 1.7)). The intervention perceived to be most effective was alternative medicine (graded as 'effective' or 'very effective' by 62.8%), followed by therapeutic exercise programmes (56.9%), bed rest (51.9%) and physical therapy (46.8%). Conclusions: Individuals reporting severe LBP were more likely to seek care. The treatment utilities perceived to be most effective were alternative medicine and therapeutic exercises, whereas the least effective were physicians' office visits. A gap was found between clinical guidelines and physicians referrals for other therapeutic interventions.