Primary healthcare physicians' adherence to acute lower back pain referral guidelines in Riyadh, Saudi Arabia.

OBJECTIVES: To assess the primary healthcare physicians' adherence to referral guidelines for acute low back pain and if there is any association with experience level.  Methods: A cross-sectional study held in Tertiary care hospital, Riyadh, Kingdom of Saudi Arabia.Questionnaires were distributed in-person between October 2017 and January 2018 among 100 primary healthcare physicians, with a 79% response rate. Results: The distribution between male to female was 43%-57%. Twenty-five percent of physicians encounter 1-5 patients weekly, while 28% encounter more than 15 patients. The physicians included had a higher than expected adherence to referral guidelines with percentages ranging between 63-94% referral rates for back pain related red flags. A trend was noted where there was an increase in referral decisions with increased experience when encountering red flags. More experienced physicians were more likely to refer when encountering; pain worse after prolonged sitting, limited mobility, and pain worse while coughing or sneezing (p less than 0.05). Conclusion: Primary healthcare physicians working in one health system in Riyadh had a higher than expected adherence to referral guidelines for back pain related red flags.