Development of a Clinical Practice Guideline for Conservative Management of Patients with Lumbar Spondylosis at Takhli Hospital, Nakhon Sawan Province
Keywords:
clinical practice guideline, conservative management, lumbar spondylosis, low back pain, community hospitalAbstract
This action research aimed to develop and evaluate a clinical practice guideline for conservative management of patients with lumbar spondylosis at Takhli Hospital, Nakhon Sawan Province. The study consisted of three phases: 1) situational analysis using medical records of 216 patients and qualitative data from 16 healthcare professionals; 2) development of a clinical practice guideline by integrating current evidence with the local hospital context; and 3) evaluation of the draft guideline in terms of appropriateness, feasibility, and acceptability among 38 healthcare professionals. Descriptive statistics were used for quantitative data, and content analysis was applied to qualitative data.
The results showed that most patients were female (61.1%), with a mean age of 61.8 ± 10.7 years. Chronic low back pain lasting more than three months was found in 72.2%. NSAIDs were prescribed in 73.1%, while physical therapy referral was documented in only 39.8%, and patient education or advice was documented in 34.3%. The major problems included the lack of a written clinical guideline, inconsistent red-flag assessment, and limited patient education and exercise prescription. The developed guideline consisted of six components: initial assessment, red-flag screening, patient classification, pharmacological management, non-pharmacological management, referral criteria, and follow-up. The scale-level content validity index of the guideline was 0.94, and the reliability of the evaluation questionnaire was 0.91. The overall evaluation score was high (4.44 ± 0.35), with appropriateness 4.55 ± 0.36, feasibility 4.31 ± 0.44, and acceptability 4.47 ± 0.40
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