Providing services for acute low-back pain: A survey of Australian physiotherapists

Objective: To determine whether physiotherapists avoid lumbar X-rays for acute non-specific low back
pain and advise people to stay active.
Methods: We conducted a cross sectional survey of Australian physiotherapists. 880 physiotherapists
were randomly sampled from Victoria (495), South Australia (158), and Western Australia (227). Physiotherapists
were asked which investigations they would order and interventions they would provide for
five acute low back pain (LBP) presentations described in vignettes. Four of the five vignettes represented
people who would not require a plain lumbar X-ray and would benefit from advice to stay active; one
described a patient with a suspected vertebral fracture and would require a plain X-ray. Participants
selected from a list of response options or provided free text responses.
Results: Questionnaires were completed by 203 of 567 potentially eligible physiotherapists (response
rate 36%). Across the four vignettes where an X-ray was not indicated, 75% (95%CI 71e78%) of physiotherapists
reported they would practice concordant with the guidelines and not order an X-ray, and 62%
(95%CI 57e66%) provided advice to stay active.
Conclusions: Most physiotherapists report intended compliance with recommendations in Australian
clinical practice guidelines (CPGs) regarding avoiding the use of X-rays and providing advice to stay
active for people with simple acute low back pain, given a vignette based scenario. The majority of
respondents reported that they would not advise bed rest. Possible opportunities to further enhance
compliance need to be developed and tested to reinforce the role of CPGs in informing physiotherapy
practice.