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. 2008 Nov;58(556):790-7, i-vi.
doi: 10.3399/bjgp08X319909.

Content and outcome of usual primary care for back pain: a systematic review

Simon Somerville  1 , Elaine Hay, Martyn Lewis, Julie Barber, Danielle van der Windt, Jonathan Hill, Gail Sowden
Affiliations

Content and outcome of usual primary care for back pain: a systematic review

Simon Somerville et al. Br J Gen Pract. 2008 Nov.

Abstract

Background: Most patients seeking help for back pain are managed in primary care.

Aim: To describe the content and outcome of 'usual care' for low back pain in primary care trials.

Design of study: A systematic review of randomised controlled trials published since 1998.

Setting: Primary care.

Method: Randomised controlled trials of back pain in adults were scrutinised to obtain data on treatment and outcome measures in groups receiving usual primary care. A narrative review of the resulting heterogeneous data was undertaken.

Results: Thirty-three papers were identified for analysis. Overall the exact nature of the treatment received in the 'usual' primary care group was poorly recorded. Medication was frequently used, and there were suggestions that levels of opioid prescription were higher than might be expected from clinical guidelines. Requesting of plain-film X-rays occurred more often than recommended. There was very little information to suggest that doctors were promoting physical activity for patients with back pain. Disability scores (Roland-Morris Disability Questionnaire) and pain scores improved over time for patients with acute or subacute back pain, but not for those with chronic pain.

Conclusion: Treatment received by patients with back pain was varied and often not in line with back-pain guidelines, particularly with respect to opioid prescription and X-ray investigation. The content of the 'usual care' arm in trials is crucial to interpreting the outcome of studies, but was poorly described in the papers reviewed. Future trials should more fully describe the 'usual care' arm.

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Figures

Figure 1
Figure 1
Systematic review flowchart.
Figure 2a
Figure 2a
Change in Roland–Morris Disability Questionnaire (RMDQ) scores over time according to duration of acute/subacute back pain.
Figure 2b
Figure 2b
Change in Roland–Morris Disability Questionnaire (RMDQ) scores over time according to duration of chronic back pain.
Figure 2c
Figure 2c
Change in Roland–Morris Disability Questionnaire (RMDQ) scores over time according to duration of mixed back pain.
See this image and copyright information in PMC

Comment in

  • Usual care in back pain trials.
    Froud R, Underwood M. Froud R, et al. Br J Gen Pract. 2009 Mar;59(560):209-10; author reply 210-1. doi: 10.3399/bjgp09X419574. Br J Gen Pract. 2009. PMID: 19275836 Free PMC article. No abstract available.

References

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    1. ACC. New Zealand acute low back pain guide. Wellington: ACC, The National Health Committee; 1997.

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