Content and outcome of usual primary care for back pain: a systematic review.
BACKGROUND
Most patients seeking help for back pain are managed in primary care.


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


METHODS
A systematic review of randomised controlled trials published since 1998.


METHODS
Primary care.


METHODS
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.


CONCLUSIONS
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.
Somerville
Simon
S
ARC National Primary Care Centre, Keele University, Keele, UK. s.j.somerville@cphc.keele.ac.uk
Hay
Elaine
E
Lewis
Martyn
M
Barber
Julie
J
van der Windt
Danielle
D
Hill
Jonathan
J
Sowden
Gail
G
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002908:Chronic Disease; D005194:Family Practice; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011364:Professional Practice / Q000592:standards; D011859:Radiography; D016032:Randomized Controlled Trials as Topic
D000701:Analgesics, Opioid