PT  - JOURNAL ARTICLE
AU  - Simon Somerville
AU  - Elaine Hay
AU  - Martyn Lewis
AU  - Julie Barber
AU  - Danielle van der Windt
AU  - Jonathan Hill
AU  - Gail Sowden
TI  - Content and outcome of usual primary care for back pain: a systematic review
AID  - 10.3399/bjgp08X319909
DP  - 2008 Nov 01
TA  - British Journal of General Practice
PG  - 790--797
VI  - 58
IP  - 556
4099  - http://bjgp.org/content/58/556/790.short
4100  - http://bjgp.org/content/58/556/790.full
SO  - Br J Gen Pract2008 Nov 01; 58
AB  - 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.