Assessing physicians' knowledge, attitudes, beliefs, and guideline adherence in the management of low back pain: A...

This study explored physicians' ability to suspect/identify specific low back pain (LBP); assess their knowledge, attitudes, and beliefs regarding non-specific LBP and self-reported knowledge of LBP guidelines; and identify physician-related factors associated with both specific and non-specific LBP management.

This cross-sectional study targeted first-line care physicians. A vignette depicting lumbar spinal stenosis (LSS) assessed the ability to suspect/identify a specific underlying cause of LBP, while the Rainville-vignette evaluated whether non-specific LBP management is guideline-consistent. Knowledge, attitudes, and beliefs were assessed using the Back Pain Attitudes Questionnaire (Back-PAQ), Health Care Provider's Pain and Impairment Relationship Scale (HC-PAIRS), and Neurophysiology of Pain Questionnaire. Physicians self-reported their guideline knowledge.

Of 100 physicians, 42 correctly mentioned LSS; 31 did so without considering other neurological or vascular causes. Eighty-two percent and 36% gave guideline-consistent recommendations for activity and work. Physicians with helpful Back-PAQ scores had higher odds (OR: 3.23) of providing guideline-consistent activity recommendations, while those with unhelpful HC-PAIRS outcomes had lower odds (OR: 0.47). Yet, 56% viewed the spine as generally vulnerable, and 94% agreed that LBP leaves a lasting weakness.

Managing LBP in first-line care remains challenging. The ability to identify specific LBP was limited and the analyses provided no clear evidence of associations with guideline knowledge or the other examined factors. Unhelpful beliefs about spinal vulnerability were also observed alongside guideline-consistent activity advice. These findings should not be interpreted as causal and point to a need for qualitative research when investigating clinical decision-making to inform targeted educational interventions.