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AB1396-HPR (2026)
GUIDELINE IMPLEMENTATION FOR LOW BACK PAIN IN GERMAN HEALTHCARE: A TALE OF OVER- AND UNDERUSE
Keywords: Physical therapy, Physiotherapy, And Physical Activity, Quality of care, Non-pharmacological interventions, Interdisciplinary research
N. Arora1,2, B. Bühring3,4, S. Vickery1, R. Schäfer1,4, L. Butry4, G. Armbrecht5, C. Bahns6, L. Danneels7, L. Donath2, K. Ehrenbrusthoff1, C. Kopkow6, C. Miller8, P. Owen9,10, D. Peschke1,11, B. Scheffler6, T. Schleimer1,11, F. Teichert1, T. Willems7, D. Belavy1
1Bochum University of Applied Sciences, Department für Pflege-, Hebammen und Therapiewissenschaften, Division of Physiotherapy, Bochum, Germany
2German Sport University Cologne, Cologne, Germany
3Cellitinnen Krankenhaus St. Josef, Bergisches Rheuma-Zentrum, Wuppertal, Germany
4Ruhr University Bochum, Bochum, Germany
5Charité-Universitätsmedizin Berlin, Department of Radiology, Berlin, Germany
6Brandenburg University of Technology Cottbus-Senftenberg, Department of Therapy Science I, Senftenberg, Germany
7Ghent University, Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent, Belgium
8School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Geelong, Australia
9Eastern Health Emergency Medicine Program, Melbourne, Australia
10Monash University, Eastern Health Clinical School, Melbourne, Australia
11Graduate School for Applied Research in North Rhine-Westphalia, Bochum, Germany

Background: Low back pain is the leading cause of disability globally and clinical practice guidelines recommend active and conservative management. However, little is known regarding guideline implementation among healthcare practitioners.


Objectives: We aimed to assess the adherence to diagnostic and treatment recommendations of German healthcare practitioners.


Methods: We conducted an online, cross-sectional clinical vignette-based survey of 658 German healthcare practitioners (medical doctors, physiotherapists, and sport scientists) between May 2022 and March 2023 to assess implementation of diagnostic and treatment recommendations for chronic non-specific low back pain, acute lumbar radiculopathy, and axial spondyloarthritis. Guideline implementation was assessed for the survey responses against recommendations from four German national guidelines. The use of clinical practice guidelines and determinants of guideline adherence were calculated. Multiple regression analyses examined predictors of guideline adherence.


Results: Among 658 healthcare practitioners, overall guideline adherence was 57.8% (treatment: 59.8%; diagnostic: 50.6%). Adherence was highest for chronic non-specific low back pain, while imaging was frequently overused for lumbar radiculopathy (MRI recommended by 84.3% (95% CI 81.1-87.5). Awareness of axial spondyloarthritis was poor, with only 32.7% (95% CI 29.2 to 36.4) correctly identifying the condition. Correct triage across the three vignettes emerged as the strongest predictor of overall guideline adherence.


Conclusions: Diagnostic and treatment adherence to national guidelines among German healthcare practitioners appears inadequate. Overuse of imaging for acute lumbar radiculopathy, delays in axial spondyloarthritis diagnosis, correct triage for specific low back pain, and underutilization of active rehabilitation for chronic non-specific low back pain are important areas for optimizing clinical care.


REFERENCES: NIL.


Acknowledgments: NIL.


Disclosure of Interests: None declared.

DOI: annrheumdis-2026-eular.C.76
Keywords: Physical therapy, Physiotherapy, And Physical Activity, Quality of care, Non-pharmacological interventions, Interdisciplinary research
Citation: , volume 85, supplement 1, year 2026, page s2349
Session: HPR Implementation and service evaluation (Publication Only)