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

Figures & data

Table 1 Demographic, Professional Profile, and Knowledge Scores of RFs Among Physicians Involved in the Study

Characteristics		N	%	Knowledge Scores		P-value
				Mean	SD
Gender	Male	141	(56.2)	79.9	(38.2)	0.230
	Female	110	(43.8)	85.5	(33.6)
Nationality	Saudi	58	(23.1)	80.4	(39.3)	0.658
	Non-Saudi	193	(76.9)	82.9	(35.5)
Age Groups	25–34 Years	66	(26.3)	76.6	(38.6)	0.291
	35–44 Years	124	(49.4)	83.4	(36.3)
	45–62 Years	61	(24.3)	86.4	(33.6)
Professional	Consultant/Specialist [FM]	69	(27.5)	90.0	(28.5)	0.182
	General Practitioner	124	(49.4)	77.6	(39.8)
	Residents [FM]	58	(23.1)	83.1	(35.8)
Years of Experiences	Less than 10	123	(49.0)	78.7	(38.1)	0.137
	10 and more	128	(51.0)	85.7	(34.3)
Number of patients with back pain seen per month	Less than 15	93	(37.1)	89.0	(30.6)	0.020
	15 and more	158	(62.9)	78.4	(38.8)
Total		251	100	82.33 95% CI [77.7–86.9]	(36.3)

Note: Maximum score = 100.

Abbreviation: FM, family medicine.

Table 2 Physicians’ Knowledge Regarding the Signs and Symptoms of Red Flags

Conditions	Proportion of Physician with Yes Responses (N%)				p-value
	All	Specialist/Consultant	General Practitioner	Residents
Symptoms of red flag that can be known through medical history and physical examination (cauda equina syndrome).
Saddle anesthesia	171(89.1)	54(87.1)	79(90.8)	38(88.4)	0.764
Bladder and bowel dysfunction (urinary retention, increased frequency or overflow incontinence)	187(97.4)	61(98.4)	84(96.6)	42(97.7)	0.870
Neurologic deficit in the lower extremity	180(93.8)	59(95.2)	81(93.1)	40(93.0)	0.856
Unexpected laxity of anal sphincter	158(82.3)	51(82.3)	72(82.8)	35(81.4)	0.982
Perineal sensory loss	172(89.6)	53(85.5)	82(94.3)	37(86.0)	0.155
Major motor weakness	179(93.2)	58(93.5)	80(92.0)	41(95.3)	0.763
Symptoms and signs of a red flag that can be known through medical history (Tumors/Infections and Trauma).
Age over 50	190(94.1)	57(98.3)	86(89.6)	47(97.9)	0.038
Age under 20	108(53.3)	26(44.8)	57(59.4)	25(52.1)	0.210
History of cancer	198(98.0)	57(98.3)	94(97.9)	47(97.9)	0.986
Constitutional symptoms	162(80.2)	46(79.3)	77(80.2)	39(81.3)	0.969
Recent bacterial infection	145(71.8)	37(63.8)	71(74.0)	37(77.1)	0.257
Drug abuse	156(77.2)	45(77.6)	75(78.1)	36(75.0)	0.912
Immune suppression	181(89.6)	54(93.1)	85(88.5)	42(87.5)	0.575
Pain that worsens when spine	175(86.6)	55(94.8)	81(84.4)	41(85.4)	0.743
Severe nighttime pain	177(87.6)	55(94.8)	81(84.4)	41(85.4)	0.140
Major trauma, such as: RTA, fall from height	185(98.4)	51(100.0)	89(97.8)	45(97.8)	0.567
Minor trauma in elderly patient /osteoporotic patient	188(86.2)	51(100.0)	79(86.8)	41(89.1)	0.028

Figure 1 Primary health care physician’s awareness of serious LBP red flags domains.

Table 3 Primary Health Care Physicians’ Practices Regarding the Red Flags

Conditions		The proportion of Physicians Who Responded with Yes (N%)				p-value
		All	Specialists/Consultants	General Practitioners	Residents
When do you refer a patient to the hospital?	All cases	23(10.6)	3(4.5)	15(15.2)	5(9.6)	0.087
	Cases with RF signs	216(99.1)	66(98.5)	99(100.0)	51(98.1)	0.419
	Cases with nonspecific low back pain	126(57.8)	33(49.3)	61(61.6)	32(61.5)	0.235
	Osteoarthritic cases	154(70.6)	33(49.3)	79(79.8)	42(80.8)	<0.001
When do you order a laboratory test?	TB/pyogenic infection	204(93.6)	63(94.0)	93(93.9)	48(92.3)	0.912
	When rheumatological diseases are suspected	198(90.8)	61(91.0)	89(89.9)	48(92.3)	0.886
When do you order an X-ray?	When acute back pain persists >2 weeks with RF sign	206(94.5)	63(94.0)	95(96.0)	48(92.3)	0.633
	2-When acute back pain persists >2 weeks without RF signs	142(65.1)	37(55.2)	69(69.7)	36(69.2)	0.123
	When acute back pain persists <2 weeks without RF signs	61(28.0)	9(13.4)	34(34.3)	18(34.6)	0.006
When do you order for CT?	When extra-spinal pathology is suspected	191(87.6)	56(83.6)	87(87.9)	48(92.3)	0.356
	If nerve root/cord compression is suspected	168(77.1)	45(67.2)	87(87.9)	36(69.2)	0.002
	3-Cauda equina lesion	179(82.1)	50(74.6)	84(84.8)	45(86.5)	0.153
	Metastatic disease	202(92.7)	61(91.0)	93(93.9)	48(92.3)	0.777
	5-Infection	102(46.8)	33(49.3)	41(41.4)	28(53.8)	0.308
When do you order for MRI?	When extra-spinal pathology is suspected	175(80.3)	49(73.1)	83(83.8)	43(82.7)	0.208
	If nerve root/cord compression is suspected	202(92.7)	64(95.5)	92(92.9)	46(88.5)	0.339
	Cauda equina lesion	203(93.1)	65(97.0)	91(91.9)	47(90.4)	0.299
	Metastatic disease	184(84.4)	54(80.6)	85(85.9)	45(86.5)	0.584
	Infection	92(42.2)	33(49.3)	39(39.4)	20(38.5)	0.331

Table 4 Factors Associated with a High Level of RF Knowledge Using the Logistic Regression Model

Factors	p-value	OR	95% C.I. for OR
			Lower	Upper
Gender (Female)	0.023	2.3	1.1	4.8
Age groups
25–34 Years	REF
35–44 Years	0.080	2.3	0.9	5.7
45–62 Years	0.216	2.2	0.6	7.6
Professional
Consultant/Specialist [FM]	REF
General Practitioner	0.052	0.4	0.2	1.0
Residents [FM]	0.575	0.8	0.3	2.0
Years of Experiences (15 years and more)	0.297	1.6	0.6	4.2
Number of patients with back pain seen per month (less than 15)	0.035	2.2	1.1	4.5

Note: The cutoff for a high level of knowledge was > 70.

Abbreviation: REF, reference category.