Methodologic issues in low back pain research in primary care.
METHODS
Narrative review and discussion of the selected literature.


OBJECTIVE
To discuss some important methodologic challenges in low back pain research in primary care.


BACKGROUND
Many methodologic problems must be confronted when conducting low back pain research. Some of these problems are back pain specific or specific to the primary care setting.


METHODS
Methodologic problems related to four research issues will be discussed: study designs, definition of low back pain, determinants of low back pain, and outcome assessment.


RESULTS
Two fundamentally different study designs are frequently used in low back pain research, namely observational studies and experimental studies. The definition of low back pain is typically restricted to a highly variables self-reported symptom, the sensation of pain in the back. There clearly is a need for an evidence-based classification system for low back pain. Because a tenable theoretical framework is lacking, it is difficult to know which determinants of low back pain should be quantified. Low back pain studies focus usually on health-related quality-of-life outcome parameters. The identification of the minimum clinically relevant changes for the most important outcome instruments needs further consideration.


CONCLUSIONS
In years to come, low back pain researchers are challenged to overcome some of these (and other) problems to enhance the quality of low back pain research in primary care.
Bouter
L M
LM
Institute for Research in Extramural Medicine, Faculty of Medicine, Vrije Universiteit Amsterdam, The Netherlands. lm.bouter.emgo@med.vu.nl
van Tulder
M W
MW
Koes
B W
BW
D002986:Clinical Trials as Topic / Q000592:standards; D006801:Humans; D017116:Low Back Pain / Q000145:classification / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care; D011788:Quality of Life; D012107:Research Design