VARIABILITY OF CLINICAL PRACTICE REGARDING BACK PAIN IN SPAIN
Title.
Variability study of clinical practice for
non-specific low back pain in Spain.
Background.
Despite the fact that low back pain ("non-specific
low back pain") is the main cause of sick leave in industrialized
countries, there is little quality scientific evidence to
support physicians' treatment of it. Furthermore, data suggests
that physicians do not base their practice on the available
evidence. As a result, different doctors have different attitudes
about which diagnostic tests to request or which treatments
to prescribe for the same patient.
The attitude of Spanish doctors towards patients with low
back pain is not known (for example, what diagnostic tests
they ask for, what treatments they prescribe and on what criteria
they base these decisions). It is essential to find this out
in order to determine the aspects in which it differs from
the recommendations based on available scientific evidence,
thus identifying the priority lines of action to be followed
to improve it.
Objectives.
-
To describe the protocols followed by Spanish doctors
when faced with patients with non-specific low back pain,
collecting the diagnostic tests and treatments they prescribe
during 1 year.
-
To describe the evolution of patients during this period
(collecting data on the evolution of their pain, limitation
of their quality of life and their work activity).
-
3. To calculate the medical and labor costs that these
patients generate in this period.
-
4. To describe the outcome ("effectiveness")
of each kind of treatment and its efficiency (relation
between its cost and effectiveness and between its cost
and the improvement in the quality of life resulting from
its use).
Methodology.
The subjects of the study were 95 physicians
from 40 Health Centers throughout the country who cared for
648 patients over 18 years old (without an end limit to age)
with non-specific low back pain who visited their office.
To determine the patients' clinical situation and their evolution,
the following were collected: their pain intensity (on a Visual
Analog Scale), their degree of disability (or limitation in
daily activities due to pain, measured on the Roland-Morris
scale), and their quality of life (measured on the EuroQol
questionnaire). A record was made of the data collection (sociodemographic
and clinical information), as well as a report on collected
economic data (direct medical and labor costs).
The clinical assessments and those of the use of health services
are made when the patient is included in the study, at 15
days, at 60 days and on demand, from that moment until the
study period ends, 6 months later.
Participants, along with the Science Department
of the Foundation.
106 researchers from 40 Primary Care centers
and Primary Care Research Units in Badajoz, Baleares, Bilbao,
Burgos, Cáceres, Cuenca, Guadalajara, Huesca, Madrid,
Murcia, Palencia, Valencia, as well as the Unit of Clinical
Biostatistics of the Hospital Ramón y Cajal, Madrid;
all of them members of the Spanish Network of Researchers
on Back Problems.
Co-funded by Kovacs Foundation and the Fund for Health Research
of the Spanish Ministry of Health and Consumer Services.
Status.
Data collection has been completed and data is currently
being analyzed.
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