Management of Low Back Pain in Primary Health-Care Settings: Physician’s Awareness and Practices Based on Red Flags

Abstract

Background

Low back pain (LBP) is one of the most common health problems. Red flags (RFs) of LBP are risk factors that are reported during clinical assessment to determine serious illness. This study aimed to assess primary health-care physicians’ knowledge of and practices for RFs of LBP and identify variables associated with a high level of knowledge and awareness about it.

Methods

An observational cross-sectional survey was conducted in 2021 among a random sample of 261 primary health care (PHC) physicians in the Jazan Region in southwest Saudi Arabia. A web-based questionnaire was used to collect data on LBP red flags awareness and practices. Descriptive (frequency and percentage) and inferential statistics were used for data analysis.

Results

The overall mean score of RFs knowledge among physicians was 82.33 ± 36.3, with 95% confidence interval (CI); (77.7–86.9). Regarding the Physician’s practices, more than 95% of the participants would refer patients to higher levels in the presence of symptoms or signs of RFs. General practitioners and residents were significantly more likely to ask for an Xray, even with symptoms that had persisted for less than 2 weeks without RF signs (p = 0.006). The overall percentage of patients with nonspecific LBP referrals was as high as 57.8%. The number of patients with LBP seen per month (fewer than 15) and female physician were associated with an increased level of knowledge (OR = 2.2, 95%, P < 0.05) and (OR = 2.2, 95%, P < 0.05) respectively.

Conclusion

Overall, awareness of RFs for LBP and referring critical patients who present with LBP is good among PHC physicians in the Jazan Region. Junior physicians have a low threshold to request images. The referral rate for nonspecific LBP is still high, which could overwhelm spinal clinics. Further educational programs for back pain management are recommended.

Keywords:

• cauda equina syndrome
• low back pain
• spinal fractures
• red flags
• spinal infection
• spinal tumor

Abbreviation

CT, Computed tomography; LBP, Low back pain; MRI, Magnetic resonance imaging; PHCs, Primary healthcare centers; RF, Red flags; TB, Tuberculosis.

Ethical Approval

The ethical approval to conduct the project was granted from the Jazan Health Ethics Committee with approval number REC2040. We conducted this study following the ethical guidelines of the Helsinki Declaration and the local guidelines of the National Committee of Bioethics, Saudi Arabia.

Disclosure

The abstract of this paper was presented at the Saudi Association of Neurological Surgery, SANS Conference as a poster presentation with interim findings. The poster’s abstract was Published as “Poster Abstracts” in the Spine Practice Journal: [https://doi.org/10.18502/jsp.v1i1.9780]. The authors report no conflicts of interest in this work.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.