Experience in Italy in the development and application of clinical guidelines for low-back pain

Clinical Guidelines (CG) reflect the up to date scientific knowledge in the treatment of Low Back Pain (LBP). The diffusion of CG and their everyday application by health care professionals is a significant problem. As most CG are developed in English, the concerns are obviously greater in non English-speaking countries. The first CG on LBP by the Quebec Task Force (1987) was introduced in 1990 by the Gruppo di Studio della Scoliosi (GSS). Some studies where planned to verify their everyday application. The first one was carried on in Mantua, and evaluated the assessment of patients by General Practitioners (GPs): there is a clear tendency to over-prescribe examinations in acute cases, while in chronic cases under-prescription is sometimes seen. An educational approach was then proposed through a number of meetings, with fable results. A third experience verified the help GPs could receive through two different educative interventions such as a booklet and a direct access to a classical Back School. In acute patients a Booklet is useful, while Back School is not; at long term follow-up, chronic cases were significantly reduced only by the Back School approach. Finally, the Abruzzo Study's results on GPs management through computer-assisted evaluation is reported. The second part of the paper deals on the new experiences that are underway on the application of Diagnostic-Therapeutic Pathways (DTP) to Low Back Disorders.