Implementation of RCGP guidelines for acute low back pain: a cluster randomised controlled trial

Abstract

Background: The Royal College of General Practitioners (RCGP) has produced guidelines for the management of acute low back pain in primary care.

Aim: To investigate the impact on patient management of an educational strategy to promote these guidelines among general practitioners (GPs).

Design of study: Group randomised controlled trial, using the health centre as the unit of randomisation.

Setting: Primary care teams in north-west England.

Method: Twenty-four health centres were randomly allocated to an intervention or control arm. Practices in the intervention arm were offered outreach visits to promote national guidelines on acute low back pain, as well as access to fast-track physiotherapy and to a triage service for patients with persistent symptoms.

Results: Twenty-four centres were randomised. Two thousand, one hundred and eighty-seven eligible patients presented with acute low back pain during the study period: 1049 in the intervention group and 1138 in the control group. There were no significant differences between study groups in the proportion of patients who were referred for X-ray, issued with a sickness certificate, prescribed opioids or muscle relaxants, or who were referred to secondary care, but significantly more patients in the intervention group were referred to physiotherapy or the back pain unit (difference in proportion = 12.2%, 95% confidence interval [CI] = 2.8% to 21.6%).

Conclusion: The management of patients presenting with low back pain to primary care was mostly unchanged by an outreach educational strategy to promote greater adherence to RCGP guidelines among GPs. An increase in referral to physiotherapy or educational programmes followed the provision of a triage service.