Management of LBP at primary care level in South Africa: up to standards?

BACKGROUND: Primary Health Care (PHC) is well suited for management of low back pain (LBP). Prevalence of (chronic) LBP is suspected to be high among visitors of the South African primary care centers, but currently no information exists on prevalence or guideline adherence.

OBJECTIVES: To establish if treatment received for LBP in public PHC in the Cape Town area compares with international evidence based guidelines.

METHODS: Cluster randomization determined the 8 community health centres where the study took place. A measurement tool was developed and validated for this population. Descriptive analysis and logistic regression analytical techniques were applied.

RESULTS: 489 participants (mean age: 44.8) were included in this study. Lifetime prevalence was 73.2% and 26.3% suffered from chronic low back pain (CLBP) . Pain medication was the only form of treatment received by 90% of the sample. Interventions received seemed to be unrelated to type of LBP (acute, sub acute and chronic). Referral to physiotherapy, education and advice to stay active were rarely done. Participants expressed low satisfaction with treatment.

CONCLUSIONS: Current management of LBP at PHC level appears to be ineffective and not conform guidelines. Further South African research should focus on barriers as well as measures to be taken for implementation of LBP guidelines.