Acute low back pain - Diagnostic and therapeutic practices reported by Brazilian rheumatologists

Study Design. A cross-sectional study. Objectives. To assess resource utilization in the diagnosis, management, and hospitalization of patients with low back pain (LBP) as prescribed by Brazilian rheumatologists. Summary of Background Data. LBP is an important cause of disability, suffering, and social costs. Two to five percent of patients miss workdays because of LBP; it is the second highest cause of physician visits and absenteeism. Methods. Rheumatologists taking part in a national rheumatology medical congress answered a questionnaire to assess management of patients with LBP. It consisted of two hypothetical scenarios describing patients with acute LBP ( scenario 1) and sciatica ( scenario 2). There were 29 questions mainly related to education, protective measures, rest, and medication. Results. A total of 207 questionnaires were returned. In scenario 1, 70% of the participants ordered some diagnostic test at first visit; lumbar radiograph was the most ordered (92%), while more than 80% prescribed rest and 100% at least one drug. Nonsteroidal anti-inflammatory drugs were prescribed by 69% of the participants. In scenario 2, 93% of the physicians ordered diagnostic tests at first visit, with computed tomography being the most ordered test ( 69%). Rest was prescribed by 90% ( average 18 days) of the participants and physical therapy was counseled by 84%. Conclusions. Considering the hypothetical scenarios, participants overused diagnostic and therapeutic procedures. A dissemination of guidelines for optimizing resource use in LBP diagnosis and management is needed.