• Alain Lorenzo, Pauline Schildt, Mathieu Lorenzo, Hector Falcoff, and Fréderique Noel.
• Faculty of Medicine, Department of General Practice, Université Paris Descartes, Sorbonne Paris Cité, Paris and alain.lorenzo@parisdescartes.fr.
• Fam Pract. 2015 Aug 1; 32 (4): 436-41.

BackgroundRecent medical guidelines for acute low back pain (aLBP) are unevenly followed. Based on financial criteria or associated with a desirability bias, studies incompletely describe the actual management provided by general practitioners (GPs) in terms of diagnosis, treatment and prevention of progression towards chronicity.ObjectiveTo compare actual practices of French GPs for aLBP management with clinical guidelines.MethodsA young simulated patient (SP) consulted, using a single scenario of aLBP, in 30 primary care practices in the Paris region.ResultsHeterogeneous data were collected according to the grid items: during the questioning, 29 GPs (97%) asked for age and 1 GP (3%) for pregnancy; during the clinical examination, 21 GPs (70%) asked for spinal stiffness and 3 GPs (10%) for cauda equina syndrome. Non-steroidal anti-inflammatory drugs were prescribed by 27 GPs (90%). Imaging (2 GPs or 7%) and physiotherapy (3 GPs or 10%) was rarely prescribed. A sick leave was prescribed by 22 GPs (73%). Twenty-seven GPs (90%) reassured the patient.ConclusionaLBP management was in line with international guidelines in terms of clinical examination, physiotherapy and imaging prescriptions and some risk factors for chronicity were taken into account. However, patient questioning was brief, and drug and sick leave prescriptions did not meet international guidelines. The SP approach seems to be a useful tool for assessing actual GP practices.© The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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