Abstract

Background: Physicians are frequently asked to adjust the work or activities of patients with chronic low back pain (CLBP). These recommendations are influenced by physicians, their attitudes and beliefs about pain, and severity of patient’s symptoms or pathology. Such recommendations may have significant impact on patients’ physical therapy program. The purpose of this study was to explore physicians’ activities and work recommendations for CLBP and to determine the predicting factors.
Methods: Questionnaires were mailed to 775 physician's in Kuwait (663 general practitioner (GPs) and 112 Orthopedic specialist (OS) ), inquiring about; Physicians demographics; age, gender, experience, education, interest in low back pain, as well as physician's rating of severity of symptoms and pathology for three CLBP vignettes, and recommendation for work and activities restrictions. Physician’s pain attitudes and beliefs were assessed by the Health Care Provider Pain and impairment relationship scale (HC-PARIS).
Results: Of the 530 returned responses; 65% were GP’S and 91% were OS. GPs encountered more CLBP patients than OS. Most physicians recommended avoidance of work and painful activities or greater work restrictions. Although the GP’s had high HC-PARIS, the OS were more restrictive in their recommendations. All physicians demonstrated consistence patterns of recommendations among the three vignettes. Significantly, physicians’ pain attitudes and belief influenced their recommendations, as did their perception of the patients’ clinical symptoms. Physicians’ experience, interest in LBP, special education in LBP, total perception of severity of symptoms, and pathology, were significant independent predictors of the total work and activity recommendations.
Conclusions: Physicians’ were not hesitant of restricting work or activities based on severity of symptoms and pathology for CLBP, regardless of their specialties, high or low HC-PAIRS scores.