Classification in nonspecific low back pain: what methods do primary care clinicians currently use?

Abstract

Study design: Postal survey.

Objectives: To describe the signs and symptoms that clinicians think represent nonspecific low back pain (NSLBP) subgroups, and to report the labels that clinicians give to those subgroups.

Summary of background data: The cause of most low back pain (LBP) cannot be diagnosed. Consequently, approximately 80% of primary care LBP presentations are most accurately labeled as NSLBP. Most Australian primary care clinicians think that NSLBP is heterogeneous and treat patients differently based on that heterogeneity. This research sought to identify the subgroups clinicians believe are recognizable within that heterogeneity.

Methods: Analysis of survey data from 651 primary care clinicians from 6 professional disciplines: physiotherapy, manipulative physiotherapy, chiropractic, osteopathy, general medicine, and musculoskeletal medicine.

Results: There was little consensus among participating clinicians regarding the signs and symptoms that identify NSLBP subgroups. Most clinicians give labels to NSLBP subgroups that imply putative pathoanatomy, however, the evidence that these labels are valid is scant and controversial.

Conclusions: A lack of consensus among participating clinicians regarding NSLBP subgroups and a lack of evidence for the validity of NSLBP subgrouping are a compelling argument for further research into this clinical practice.