Awareness of Red Flags in Acute Low Back Pain and Their Assessment Among Primary Healthcare Physicians in Nairobi, Kenya

Abstract

Background: Back pain (BP) is a highly prevalent health issue that affects a significant portion of the general population. It is a leading cause of disability on a global scale. Red flags of back pains are critical indicators and symptoms that are identified through a thorough examination of a patient's history and a detailed clinical assessment and serve as important clues, suggesting the possibility of a significant underlying disease that may not be immediately apparent. These red flags are crucial in guiding doctors and medical practitioners in making decisions about the necessity for additional diagnostic tests, specialist referrals, or immediate interventions. Globally a significant number of primary care physicians do not follow the guidelines on red flags in back pains. There is need to identify the knowledge and practice gaps in implementation of red flags to improve patient care. Objectives: To assess the knowledge and practice on red flags on care of patients with low back pains amongst non-specialist health care workers in outpatient departments at 5 urban hospitals in Nairobi, Kenya. Methodology: Descriptive cross-sectional study carried out at 5 urban centers within Nairobi namely, Kenyatta National Hospital, Mbagathi Hospital, Aga Khan University Hospital, Mama Lucy Hospital, Mater Hospital. Stratified proportionate sampling was used where 119 primary healthcare physicians were recruited into the study. Data analysis: The analysis utilized both descriptive and inferential analysis where for descriptive analysis frequencies and percentages were used. Proportion of study participants with adequate level of awareness on low back pains was determined by calculating the proportion of the total scores of all questions, converted into percentage and rated using Blooms criteria which established that a score of ≥80% was considered adequate level of awareness. Level of assessment was also scored using Blooms criteria where a percentage score of ≥60 was considered good level of assessment based on Blooms criteria. Fischer’s exact test or Pearson chi-square were conducted to investigate association between respondent characteristics with both awareness and assessment. Stata 16.0 was used for data analysis. Results: The mean age was 33.3(SD±4.2) years with majority of them aged between 30 and 40 years, 53%(n =63) of the primary healthcare physicians were male. Majority of the respondents were resident 66.4%(n =79). In investigating years of experience, 52.1%(n =62) had between 6 to 10 years of experience while 39.5%(n =47) had ≤5 years of experience and 42%(n =50) of the respondents had formal training. Majority of the primary healthcare physicians were able to identify some of the red flag signs for acute back pain although the self-reported confidence in identifying the red flags was low with a lower overall knowledge level of 27%. The findings established that gender (p =0.026) and having training on red flags identification (P<0.001) were significantly associated with assessment. The results also showed that age ( p =0.023), gender (p =0.033), cadre (p =0.013) and receiving formal training (p =0.008) on red flags were significantly associated with level of awareness.

Conclusion and recommendations: Level of awareness and assessment of red flags for acute back pain is low hence there is need for implementation of comprehensive and continuous training programs focusing on red flag identification for acute back pain.