Improving adherence among primary-care providers to clinical-practice guidelines for the diagnosis and treatment of acute low-back pain

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Montana State University - Bozeman, College of Nursing


Back pain is a condition primary-care providers will inevitably see among their patients. It is one of the most prevalent medical conditions, affecting between 50% and 90% of the general adult population in developed countries. Nonspecific low-back pain accounts for approximately 85% of all low-back-pain incidents in primary care, and the majority of these episodes will resolve within two weeks of onset. Care for low-back pain is often fragmented and results in a very heavy economic burden from both direct and indirect costs. Clinical-practice guidelines have been developed to improve patient care and outcomes, and decreased healthcare costs have been demonstrated when clinical-practice guidelines are followed. However, despite the wide availability of clinical-practice guidelines, adherence by primary-care providers is less than optimal. Therefore, the purpose of this project is to evaluate the effectiveness of an educational program for primary-care providers in a rural clinic regarding the proper management of acute low-back pain following available clinical-practice guidelines. A quasi-experimental project design with retrospective chart reviews was conducted. Data from the first review, along with current evidence-based protocols for back-pain management, were used to develop an educational presentation for the primary-care providers of a family-medicine clinic in a rural, southwest Montana town. A second chart review was performed after the educational presentation to evaluate utilization of the evidence-based protocol of the primary-care providers. Results indicated a significant improvement in the prescription of methylprednisolone by primary-care providers, decreasing from 40% during the initial retrospective chart review to 0% during the second retrospective chart review. Other areas of the outcomes data, although not significant, showed improvement related to adherence to the clinical-practice guidelines by the primary-care providers. This indicates the educational intervention was overall successful in fulfilling the purpose of this project.




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