Do Norwegian manual therapists provide management for patients with acute low back pain in accordance with clinical guidelines?

Manual therapists (MTs) are specialized in examining and treating patients with low back pain (LBP). The aim of the study was to investigate if patients' consultations with Norwegian MTs are in accordance with clinical guidelines for the management of acute LBP. Semi-structured interviews were conducted based on observation of the first consultation. Twenty-two MT students observed two consultations, and thereafter interviewed MTs (convenience sample) about clinical findings, information, advice and specific therapeutic procedures given. The interviews were tape-recorded, transcribed, and organized. Forty-two reports were derived from 34 MTs (12% of all in Norway). The MTs commonly informed the patients of main clinical findings. The intention to eliminate fear avoidance was specifically mentioned in 43% of the interviews. Advice of being active in daily life activities was given to 50% of the patients, and 43% were advised to avoid particular pain provoking movements. Working ability and sick leave was considered in only 20% of those employed. The most frequent treatment modalities recommended were home-exercises (69%) and a combination of joint mobilization and individually tailored exercises (48%). To some extent the MTs acted according to main points of clinical guidelines. However, functioning at the participation level was little emphasized in the consultations.