Experience in Italy in the development and application of clinical guidelines for low back pain.

UNLABELLED: Clinical Guidelines (CG) reflect the up to date scientific knowledge in the treatment of Low Back Pain (LBP). The diffusion of CG and their everyday application by health care professionals is a significant problem. As most CG are developed in English, the concerns are obviously greater in non English-speaking countries. The first CG on LBP by the Quebec Task Force (1987) was introduced in 1990 by the Gruppo di Studio della Scoliosi (GSS). Some studies where planned to verify their everyday application. The first one was carried on in Mantua, and evaluated the assessment of patients by General Practitioners (GPs): there is a clear tendency to over-prescribe examinations in acute cases, while in chronic cases under-prescription is sometimes seen. An educational approach was then proposed through a number of meetings, with fable RESULTS: A third experience verified the help GPs could receive through two different educative interventions such as a booklet and a direct access to a classical Back School. In acute patients a Booklet is useful, while Back School is not; at long term follow-up, chronic cases were significantly reduced only by the Back School approach. Finally, the Abruzzo Study's results on GPs management through computer-assisted evaluation is reported. The second part of the paper deals on the new experiences that are underway on the application of Diagnostic-Therapeutic Pathways (DTP) to Low Back Disorders.

The backpack load in schoolchildren: clinical and social importance, and efficacy of a community-based educational intervention. A prospective controlled cohort study.

AIM: The aims of this paper were: to establish the efficacy of an educational intervention in reducing school backpack weight and, possibly, back pain; to verify the content of backpacks and the social importance of the problem; to confirm existing data in the literature. DESIGN: controlled prospective educational intervention. SETTING: community. PARTICIPANTS: the entire Year 6 population (402 pupils) of 2 randomly chosen rural school districts of the province of Mantua (Italy); of these, we took 108 (selected according to position in the class register): 82.4% completed the study; 402 parents and 124 teachers entered the study, 77.1% and 37.1% respectively completed it. INTERVENTION: instructive meeting and written material for teachers, and a leaflet for parents on backpack management. MAIN OUTCOME MEASURES: backpack weight and content; back pain; subjective perceptions of backpack load; packing and carrying methods; backpack load: importance, management and education; backpack characteristics. RESULTS: We obtained a statistically significant reduction in the backpack weight in each of the groups (study 11.2%; control 7.9% - not a statistically significant difference); 90.1% of the material carried is necessary. Backpacks are considered a problem by 95.1% of parents, 73% of teachers, and 60.3% of pupils. Backpack weight: 8.75+/-1.26 kg (19.9+/-5.3% of body weight); fatigue during backpack carrying: 72.7%; back pain life prevalence: 58.4%; fatigue during backpack carrying and considering backpacks a problem were associated with back pain (odds ratios 4.4 and 5). CONCLUSIONS: Educational intervention is not the answer to the problem and solutions, like the clear legal limits established for adults, need to be found.

General practitioners' management of low back pain: impact of clinical guidelines in a non-English-speaking country.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To evaluate the assessment of patients with low back pain by general practitioners (GPs) in a non-English-speaking country and to compare their behavior with AHCPR and CSAG clinical guidelines. SUMMARY OF BACKGROUND DATA: The diffusion of clinical guidelines (and their everyday application by health care professionals) is a significant problem. Because most guidelines are developed in English, concerns over their diffusion are obviously greater in non-English-speaking countries. METHODS: A questionnaire was sent to all the GPs in the province of Mantua, Italy (n = 318). The authors evaluated what examinations are routinely performed and what danger symptoms and signs prompt referral of patients. GPs indicated the frequency of their prescription of radiographs, computed tomography scans, magnetic resonance imaging, laboratory tests, and consultations. The findings were compared with a "gold standard": the AHCPR and CSAG clinical guidelines. RESULTS: The response rate was 68.2%. Only 28.0% of GPs perform all the tests considered important by the clinical guidelines, and 33.0% were aware of all the red flags. Correspondence with the clinical guideline recommendations ranged from 14.6% to 89.4%. There is a clear tendency to overprescribe examinations in acute cases, whereas in chronic cases underprescription is sometimes seen. CONCLUSIONS: In a non-English-speaking country the evaluation of low back pain by GPs does not reflect current recommendations, and the situation is seen to be worse than in English-speaking countries. Concerns over the diffusion of guidelines must therefore be considered greater in non-English-speaking countries, where thorough presentation to GPs of the existing "evidence-based" guidelines is to be recommended.