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Patient Nonadherence to Guideline-Recommended Care in Acute Low Back Pain

BIER JD; KAMPER SJ; VERHAGEN AP; MAHER CG; WILLIAMS CM
ARCH PHYS MED REHABIL , 2017, vol. 98, n° 12, p. 2416-2421
Doc n°: 186371
Localisation : Documentation IRR

D.O.I. : http://dx.doi.org/DOI:10.1016/j.apmr.2017.05.029
Descripteurs : CE51 - LOMBALGIE

OBJECTIVE: To describe the magnitude of patient-reported nonadherence with
guideline-recommended care for acute low back pain. DESIGN: Secondary analysis of
data from participants enrolled in the Paracetamol for Acute Low Back Pain study
trial, a randomized controlled trial evaluating the effectiveness of paracetamol
for acute low back pain. SETTING: Primary care, general practitioner.
PARTICIPANTS: Data from participants with acute low back pain (N=1643).
INTERVENTIONS: Guideline-recommended 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 MEASURES: Proportion
of nonadherence with guideline-recommended care. Nonadherence was defined as (1)
failure to consume the advised paracetamol dose, or (2) receipt of additional
health care, tests, or medication during the trial treatment period (4wk).
Multivariable logistic regression analysis was performed to determine the factors
associated with nonadherence. RESULTS: In the first week of treatment, 39.7% of
participants were classified as nonadherent. Over the 4-week treatment period,
70.0% were nonadherent, and 57.5% did not complete the advised paracetamol
regimen. Higher perceived risk of persistent pain, lower level of disability, and
not claiming workers' compensation were associated with nonadherence, with odds
ratios ranging from .46 to 1.05. CONCLUSIONS: Adherence to guideline-recommended
care for acute low back pain was poor. Most participants do not complete the
advised paracetamol regimen. Higher perceived risk of persistence of complaints,
lower baseline disability, and participants not claiming workers' compensation
were independently associated with nonadherence.
CI - Copyright (c) 2017 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS

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