Influence of low back pain characteristics on the healthcare procedures prescribed by general practitioners for adult patients: ancillary analysis of the French ECOGEN study
Bibliographic record
Abstract
Non-specific low back pain is a frequent reason for consultation, yet little is known about how general practitioners manage it in France. To describe the healthcare procedures general practitioners prescribe for low back pain in France. This is an ancillary analysis of an observational, cross-sectional study (ECOGEN) conducted between November 2011 and April 2012 among 128 general practitioners. Adults younger than 65 years consulting for low back pain were included. Patient and general practitioner characteristics, consultation results (diagnosis) and healthcare procedures were collected and coded using the International Classification in Primary Care. Analyses focused on the initial or follow-up consultation, adjusting on age, gender, and socio-occupational category. Out of 11510 consultations, 845 (7.3%) were for low back pain. Of these, 776 (79.5%) resulted in a clinical examination, 634 (73.4%) in medication prescription, and 203 (23.9%) were prescribed sick leave, but imaging and specialist referral were rare. Imaging was more frequent with radiating pain (adjusted odds ratio (aOR) = 1.61; 95% CI [1.07, 2.42]), as were specialist referrals (OR = 2.92; 95% CI [1.40, 6.09]) and sick leave prescription (aOR = 1.52; 95% CI [1.10, 2.09]), but physiotherapist referral was less frequent (aOR = 0.55; 95% CI [0.38, 0.82]). Clinical examinations (aOR = 2.75; 95% CI [1.98, 3.80]), imaging (aOR = 1.61; 95% CI [1.02, 2.31]) and medication prescriptions (aOR = 2.34; 95% CI [1.65, 3.30]) were more common in initial consultations, but specialist referral (aOR = 0.16; 95% CI [0.05, 0.47]) or sick leave prescription (aOR = 0.68; 95% CI [0.48, 0.97]) were rarer. Low back pain characteristics could influence healthcare procedures more markedly than patient or general practitioner characteristics. Les douleurs lombaires non spécifiques sont un motif fréquent de consultation, mais on en sait peu sur la manière dont les médecins généralistes gèrent ces plaintes. Décrire les soins prodigués ou prescrits par les médecins généralistes en France pour les douleurs lombaires. Il s'agit d'une analyse secondaire de l'étude ECOGEN, une étude observationnelle et transversale menée entre novembre 2011 et avril 2012 auprès de 128 médecins généralistes. Étaient inclus les adultes de moins de 65 ans qui consultaient pour des douleurs lombaires. Les caractéristiques des patients et des praticiens, le résultat de la consultation (diagnostics) et les soins prodigués ou prescrits étaient collectés et codés selon la classification internationale en soins primaires. Les analyses ont distingué les consultations initiales ou de suivi, en ajustant pour l'âge, le sexe et la catégorie socio-professionnelle. Sur 11510 consultations, 845 (7,3 %) étaient motivées par des douleurs lombaires. Parmi celles-ci, 776 (79,5 %) ont conduit à un examen clinique, 634 (73,4 %) à une ordonnance de médicament et 203 (23,9 %) à un arrêt de travail. La prescription d'imagerie et le renvoi vers un spécialiste étaient peu fréquents. La prescription d'imagerie était plus fréquente en cas de douleurs irradiantes (Odds ratio (OR) ajusté = 1,61 ; IC95 % [1,07-2,42]), de même que l'adressage à un spécialiste (OR ajusté = 2,92 ; IC95 % [1,40-6,09]) et l'arrêt de travail (OR ajusté = 1,52 ; IC95 % [1,10-2,09]). En revanche, la prescription de kinésithérapie était moins fréquente (OR ajusté = 0,55 ; IC95 % [0,38-0,82]). L'examen clinique (OR ajusté = 2,75 ; IC95 % [1,98-3,80]), l'imagerie (OR ajusté = 1,61 ; IC95 % [1,02-2,31]) et la prescription de médicaments (OR ajusté = 2,34 ; IC95 % [1,65-3,30]) étaient plus fréquents en consultation initiale, mais l'adressage chez un spécialiste (OR ajusté = 0,16 ; IC95 % [0,05-0,47]) et l'arrêt de travail (OR ajusté = 0,68 ; IC95 % [0,48-0,97]) étaient moins fréquents. Les caractéristiques des douleurs lombaires pourraient influencer les soins prodigués ou prescrits plus fortement que les caractéristiques des patients ou celles des praticiens.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".