The changing face of acute low back pain management by physiotherapists, osteopaths and chiropractors in the UK: a 20-year comparison from 2003 to 2023.

BACKGROUND

Low back pain (LBP) remains a leading source of disability and societal cost. In the UK, physiotherapists, osteopaths, and chiropractors are front-line providers of LBP care. Despite widespread dissemination of clinical guidelines, little is known about how their clinical practice has changed over time.

METHODS

We conducted national surveys of UK physiotherapists, osteopaths and chiropractors in 2003 and 2023, using an identical acute non-specific LBP vignette to assess reported use of investigations and interventions at both time points.

RESULTS

A total of 1,758 eligible clinicians participated in 2003 (834 physiotherapists; 592 osteopaths; and 332 chiropractors), and 1,388 in 2023 (511 physiotherapists; 621 osteopaths; and 255 chiropractors). At both time-points, there were significant inter-professional differences and numerous departures from guideline recommendations. Substantial temporal changes were observed. Physiotherapists shifted towards more restrictive recommendations for work and bed-rest, towards the use of massage, away from spinal mobilization, away from specific exercises, and away from general advice on back care. Chiropractors shifted towards more restrictive recommendations for bed-rest, towards spinal mobilization and acupuncture, and away from spinal manipulation and ultrasound. Osteopaths shifted towards less restrictive recommendations for activity, work, and bed-rest, towards acupuncture, and away from spinal manipulation.

CONCLUSIONS

Between 2003 and 2023, UK physiotherapists, osteopaths, and chiropractors reported evolving management approaches to acute LBP. Substantial inter-professional differences and divergences from guideline recommendations were observed. Some inter-professional differences narrowed over time, suggesting partial convergence of practice.