The approach of physiatrists to low back pain across Europe

Article type: Research Article

Authors: Dincer, Fitnat^{a; *} | Kesikburun, Serdar^b | Ozdemir, Oya^a | Yaşar, Evren^b | Munoz, Susana^c | Valero, Raquel^c | Juocevidius, Alvydas^d | Quittan, Michail^e | Lukmann, Aet^f | Winkelman, Andreas^g | Vetra, Anita^h | Gerdle, Björnⁱ | Kiekens, Carlotte^j | Branco, Catarina Aguiar^k | Smith, Eimear^l | Delargy, Mark^m | Ilieva, Elenaⁿ | Boyer, François Constant^o | Grubisic, Frane^p | Damjan, Hermina^q | Krüger, Liisamari^r | Kankaanpää, Markku^s | Dimitrova, Erieta Nikolikj^t | Delic, Marina^u | Lazovic, Milica^v | Tomic, Natasa^w | Roussos, Nikolaos^x | Michail, Xanthi^y | Boldrini, Paolo^z | Negrini, Stefano^aa | Takac, Peter^bb | Tederko, Piotr^cc | Angerova, Yvona^dd

Affiliations: [a] Department of Physical Medicine and Rehabilitation, School of Medicine, Hacettepe University, Ankara, Turkey | [b] Department of Physical Medicine and Rehabilitation, Gülhane School of Medicine, University of Health Sciences, Gaziler Physical Therapy and Rehabilitation Research and Training Hospital, Ankara, Turkey | [c] Department Medicina Fisica y Rehabilitacion, Universidad Complutense, Madrid, España | [d] Rehabilitation, Physical and Sports Medicine Center, Medical Faculty, Vilnius University, Vilnius, Lithuania | [e] Institute of PMR, Kaiser-Franz-Joseph-Hospital, Vienna, Austria | [f] Department of Sports Medicine and Rehabilitation, University of Tartu, Tartu, Estonia | [g] Klinik und Poliklinik für Physikalische Medizin und Rehabilitation, München, Germany | [h] National Rehabilitation Center, Neurological Rehabilitation, Jurmala, Latvia | [i] Pain and Rehabilitation Center, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden | [j] Physical and Rehabilitation Medicine, University Hospitals Leuven, Holsbeek, Belgium | [k] Rehabilitation Medicine Department, Hospital São Sebastião, CHEDV, Santa Maria da Feira, Portugal | [l] National Rehabilitation and Mater Misericordiae University Hospital, Dublin, Ireland | [m] National Rehabilitation Hospital, Dun Laoghaire, Dublin, Ireland | [n] Department of Physical and Rehabilitation Medicine, Medical University Hospital, Plovdiv, Bulgaria | [o] Department of Physical and Rehabilitation Medicine, Champagne Ardenne University Reims, Reims, France | [p] Department of Rheumatology, Physical Medicine and Rehabilitation, School of Medicine, University of Zagreb, University Hospital Center “SestreMilosrdnice”, Zagreb, Croatia | [q] Institute for Rehabilitation, Ljubljana, Slovenia | [r] Orton Rehabilitation Centre, Orton Orthopaedic Hospital, Helsinki, Finland | [s] Department of Physical and Rehabilitation Medicine, Tampere University Hospital, Tampere, Finland | [t] Institute for Physical Medicine and Rehabilitation, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia | [u] Topla III, Herceg Novi, Montenegro | [v] Faculty of Medicine Belgrade and Institute for Rehabilitation Belgrade, Belgrade, Serbia | [w] Institute for the Physical Medicine and Rehabilitation “Dr. Miroslav Zotovic”, Banjaluka, Republika Srpska | [x] Asklipeion General Hospital, Athens, Greece | [y] ATEI, Athens, Greece | [z] Rehabilitation Department, Azienda ULSS 2, Treviso, Italy | [aa] University of Brescia, IRCCS Don Gnocchi Milan, Clinical and Experimental Sciences, Physical and Rehabilitation Medicine, Milan, Italy | [bb] Pavol Jozef Safarik University in Kosice Faculty of Medicine, L. Pasteur University Hospital, Kosice, Slovak Republic | [cc] Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland | [dd] Department of Rehabilitation Medicine, General Teaching Hospital Prague, Prague, Czech Republic

Correspondence: [*] Corresponding author: Fitnat Dincer, Department of Physical Medicine and Rehabilitation, School of Medicine, Hacettepe University, Ankara, Turkey. Tel.: +90 (312) 305 15 74; E-mail: fitnatdincer@gmail.com.

Abstract: BACKGROUND: Low back pain (LBP) is the most common type of musculoskeletal pain, thus it is one of the most commonly encountered conditions in Physical and Rehabilitation Medicine. The physicians who are primarily responsible for the nonsurgical management of LBP are physiatrists. OBJECTIVE: The present study aimed to investigate the approaches of physiatrists to low back pain across Europe. Preferences, tendencies, and priorities in the diagnosis, management, and treatment of LBP, as well as the epidemiological data pertaining to LBP in PRM practice were evaluated in this Europe-wide study. METHODS: The study was conducted under the control of the European Society of Physical and Rehabilitation Medicine (ESPRM) Musculoskeletal Disorders Research Committee. A total of 576 physiatrists from most European countries participated in the survey. RESULTS: The results show that physiatrists frequently deal with patients with LBP in their daily practice. Most patients are not referred to other departments and are treated with various conservative methods. Less than one-fifth of patients are primarily referred for surgery. The physiatrists believe that a clear diagnosis to account for cases of low back pain is rarely established. The most common diagnosis is discopathy. History and physical examination remain the most valuable clinical evaluation tools for low back pain according to physiatrists. Less than half the patients require a magnetic resonance imaging. Non-steroidal anti-inflammatory drugs are the most commonly prescribed drugs for low back pain. Exercise, back care information, and physical therapy are the preferred conservative treatments. More than half of the physiatrists offer interventional treatments to patients with low back pain. CONCLUSION: The present study is a preliminary report that presents the attitudes of European physiatrists in the management of low back pain. Further researches are warranted to standardize the conservative management of LBP.

Keywords: Low back pain, physiatrist, conservative management, rehabilitation

DOI: 10.3233/BMR-171001

Journal: Journal of Back and Musculoskeletal Rehabilitation, vol. 32, no. 1, pp. 131-139, 2019