To test the validity of a nurse administered protocol for low back pain, a prospective trial of 419 patients was undertaken in a walk in clinic. In all, 222 patients were randomly allocated to a 'nurse protocol group' in which they were evaluated by 1 of 5 nurses using the protocol; the nurses independently managed 53% of the patients and referred to a physician patients with potentially complex conditions. In addition, 197 patients in a randomly allocated control group were managed by one of 32 physicians. Care in the experimental and control groups was compared by follow up telephone contact and by a four month chart review. There was no significant difference in symptomatic relief or the development of serious disease in the two groups. Nurse protocol patients expressed greater satisfaction with the care they had received; patient satisfaction correlated positively with symptom relief. In over 95 percent of the patients, there were noncomplex, nonserious, nonchronic conditions as the cause of back pain. The authors conclude that nurse protocol management of this generally benign condition in a primary care setting is both effective and efficient.
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