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Physical Therapists' Use of Interventions With High Evidence of Effectiveness in the Management of a Hypothetical Typical Patient With Acute Low Back Pain

C Mikhail, MSc, is Physical Therapist, Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, 3630 Promenade Sir William Osler, Montreal, Quebec, Canada H3G 1Y5 (christine.mikhail{at}mail.mcgill.ca)
N Korner-Bitensky, PhD, is Associate Professor, Faculty of Medicine, School of Physical and Occupational Therapy, McGill University
M Rossignol, MD, MSc, FRCP, is Consulting Physician, Department of Occupational and Environmental Health, Direction de la Santé Publique, Montreal, Quebec, Canada
JP Dumas, MSc, is Physical Therapist and Faculty Lecturer, Faculty of Medicine, School of Physical and Occupational Therapy, McGill University

Address all correspondence to Ms Mikhail

Background and Purpose. Evidence-based practice aims to improve patient care and service delivery, particularly in the management of individuals with low back pain (LBP), the largest client group seen by outpatient physical therapists. The purpose of this study was to determine the prevalence of use of interventions with evidence of effectiveness in the management of acute nonspecific LBP by physical therapists. Subjects. A multicenter cross-sectional study was conducted on 100 physical therapists working with patients with LBP. Methods. Using a telephone-administered interview, therapists described their current and desired treatment practices for a typical case of LBP. Each intervention reported was coded according to its evidence of effectiveness (strong, moderate, limited, or none). Information on clinician, workplace, and client characteristics also was obtained. Results. The prevalence of use of interventions with strong or moderate evidence of effectiveness was 68%. However, 90% to 96% of therapists also used interventions for which research evidence was limited or absent. Users of interventions with high evidence of effectiveness, as compared with nonusers, had graduated more recently and had taken a higher number of postgraduate clinical courses. Discussion and Conclusion. Although most therapists use interventions with high evidence of effectiveness, much of their patient time is spent on interventions that are not well reported in the literature. The results indicate the need for improvement in the quality of clinical research as well as its dissemination and implementation in a way that is appealing to therapists, such as through practice-related courses.

Key Words: Back pain • Evidence-based practice • Health care surveys • Practice guidelines

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