General practitioners' attitudes and beliefs regarding the management of chronic low back pain in Ireland: a cross-sectional national survey

Brona M Fullen, G David Baxter, Catherine Doody, Leslie E Daly, Deirdre A Hurley
Clinical Journal of Pain 2011, 27 (6): 542-9

OBJECTIVES: General practitioners (GPs) manage the majority of patients with chronic low back pain (LBP) in the Republic of Ireland's health system; however, little is known about their attitudes and beliefs, and how these influence their practice behavior. This study aimed to determine the attitudes and beliefs of GPs regarding chronic LBP, the factors that influence these, and their impact on the management of patients with chronic LBP.

METHOD: A cross-sectional questionnaire survey of a random sample of GPs (n = 750) was undertaken. The questionnaire pack contained a demographic questionnaire, an attitudes measure (the Pain Attitudes and Beliefs Scale, which measured "biomedical" and "biopsychosocial" orientations), and 2 LBP clinical vignettes.

RESULTS: The response rate was 57% (n = 432). Doctor-related factors (use of LBP clinical guidelines, number of years qualified) had a statistically significant impact on biomedical scores, that is, those who used guidelines, and were qualified a shorter time had significantly lower biomedical scores (P < 0.05); however, they had a limited impact on the consultation outcomes. No doctor-related factor impacted on the biopsychosocial score, and only sex impacted on the consultation outcome, that is, female GPs referred patients more frequently to allied health professionals.

DISCUSSION: The current results show partial adherence to current LBP guidelines: GPs manage patients within a biomedical framework, and postgraduate education is not significantly impacting on chronic LBP management. GPs' beliefs do not correlate with their management, which only reflects partial adherence to LBP guideline recommendations. Further research is needed to explore the role of patient factors in the consultation outcomes.

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