Patient non-adherence to guideline-recommended care in acute low back pain

Publication date: Available online 6 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jasper D. Bier, Steven J. Kamper, Arianne P. Verhagen, Christopher G. Maher, Christopher M. Williams
ObjectiveTo describe the magnitude of patient reported non-adherence with guideline-recommended care for acute low back pain.DesignSecondary analysis of data from participants enrolled in the PACE trial, a randomised controlled trial evaluating the effectiveness of paracetamol for acute low back pain.ParticipantsData from 1643 participants with acute low back pain.InterventionsGuideline recommendend care including; reassurance, simple analgesia, and the advice to stay active and avoid bed rest. Also advice against additional treatments and referral for imaging.Main Outcome MeasuresProportion of non-adherence with guideline-recommended care. Non-adherence was defined as 1) failure to consume the advised paracetamol dose, or 2) receipt of additional healthcare, tests, or medication during the trial treatment period (4 weeks). Multivariable logistic regression analysis was preformed to determine the factors associated with non-adherence.ResultsIn the first week of treatment, 39.7% of the participants were classified as non-adherent. Over the 4-week treatment period 70.0% were non-adherent, 57.5% did not consume the advised paracetamol dose. Higher perceived risk of persistent pain, lower level of disability and not claiming workers' compensation were associated with non-adherence with odds ratios ranging from 0.46 to 1.05.ConclusionsAdherence to guideline-recommended care for acute low back pain was poor. Most participants do not take the advised paracetamol dose. Higher perceived risk of persistence of complaints, lower baseline disability and participants not claiming workers' compensation were independently associated with non-adherence.



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