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Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial.
BMJ. 2001 Feb 17; 322(7283):400-5.BMJ

Abstract

OBJECTIVE

To test the hypothesis that radiography of the lumbar spine in patients with low back pain is not associated with improved clinical outcomes or satisfaction with care.

DESIGN

Randomised unblinded controlled trial.

SETTING

73 general practices in Nottingham, north Nottinghamshire, southern Derbyshire, north Lincolnshire, and north Leicestershire. 52 practices recruited participants to the trial.

SUBJECTS

421 patients with low back pain of a median duration of 10 weeks.

INTERVENTION

Radiography of the lumbar spine.

MAIN OUTCOME MEASURES

Roland adaptation of the sickness impact profile, visual analogue scale for pain, health status, EuroQol, satisfaction with care, use of primary and secondary care services, and reporting of low back pain at three and nine months after randomisation.

RESULTS

The intervention group were more likely to report low back pain at three months (relative risk 1.26, 95% confidence interval 1.00 to 1.60) and had a lower overall health status score and borderline higher Roland and pain scores. A higher proportion of participants consulted their doctor in the three months after radiography (1.62, 1.33 to 1.97). Satisfaction with care was greater in the group receiving radiography at nine but not three months after randomisation. Overall, 80% of participants in both groups at three and nine months would have radiography if the choice was available. An abnormal finding on radiography made no difference to the outcome, as measured by the Roland score.

CONCLUSIONS

Radiography of the lumbar spine in primary care patients with low back pain of at least six weeks' duration is not associated with improved patient functioning, severity of pain, or overall health status but is associated with an increase in doctor workload. Guidelines on the management of low back pain in primary care should be consistent about not recommending radiography of the lumbar spine in patients with low back pain in the absence of indicators for serious spinal disease, even if it has persisted for at least six weeks. Patients receiving radiography are more satisfied with the care they received. The challenge for primary care is to increase satisfaction without recourse to radiography.

Authors+Show Affiliations

Division of General Practice, School of Community Health Sciences, University Park, Nottingham NG7 2RD. denise.kendrick@nottingham.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11179160

Citation

Kendrick, D, et al. "Radiography of the Lumbar Spine in Primary Care Patients With Low Back Pain: Randomised Controlled Trial." BMJ (Clinical Research Ed.), vol. 322, no. 7283, 2001, pp. 400-5.
Kendrick D, Fielding K, Bentley E, et al. Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. BMJ. 2001;322(7283):400-5.
Kendrick, D., Fielding, K., Bentley, E., Kerslake, R., Miller, P., & Pringle, M. (2001). Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. BMJ (Clinical Research Ed.), 322(7283), 400-5.
Kendrick D, et al. Radiography of the Lumbar Spine in Primary Care Patients With Low Back Pain: Randomised Controlled Trial. BMJ. 2001 Feb 17;322(7283):400-5. PubMed PMID: 11179160.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. AU - Kendrick,D, AU - Fielding,K, AU - Bentley,E, AU - Kerslake,R, AU - Miller,P, AU - Pringle,M, PY - 2001/2/17/pubmed PY - 2001/3/27/medline PY - 2001/2/17/entrez SP - 400 EP - 5 JF - BMJ (Clinical research ed.) JO - BMJ VL - 322 IS - 7283 N2 - OBJECTIVE: To test the hypothesis that radiography of the lumbar spine in patients with low back pain is not associated with improved clinical outcomes or satisfaction with care. DESIGN: Randomised unblinded controlled trial. SETTING: 73 general practices in Nottingham, north Nottinghamshire, southern Derbyshire, north Lincolnshire, and north Leicestershire. 52 practices recruited participants to the trial. SUBJECTS: 421 patients with low back pain of a median duration of 10 weeks. INTERVENTION: Radiography of the lumbar spine. MAIN OUTCOME MEASURES: Roland adaptation of the sickness impact profile, visual analogue scale for pain, health status, EuroQol, satisfaction with care, use of primary and secondary care services, and reporting of low back pain at three and nine months after randomisation. RESULTS: The intervention group were more likely to report low back pain at three months (relative risk 1.26, 95% confidence interval 1.00 to 1.60) and had a lower overall health status score and borderline higher Roland and pain scores. A higher proportion of participants consulted their doctor in the three months after radiography (1.62, 1.33 to 1.97). Satisfaction with care was greater in the group receiving radiography at nine but not three months after randomisation. Overall, 80% of participants in both groups at three and nine months would have radiography if the choice was available. An abnormal finding on radiography made no difference to the outcome, as measured by the Roland score. CONCLUSIONS: Radiography of the lumbar spine in primary care patients with low back pain of at least six weeks' duration is not associated with improved patient functioning, severity of pain, or overall health status but is associated with an increase in doctor workload. Guidelines on the management of low back pain in primary care should be consistent about not recommending radiography of the lumbar spine in patients with low back pain in the absence of indicators for serious spinal disease, even if it has persisted for at least six weeks. Patients receiving radiography are more satisfied with the care they received. The challenge for primary care is to increase satisfaction without recourse to radiography. SN - 0959-8138 UR - https://www.unboundmedicine.com/medline/citation/11179160/Radiography_of_the_lumbar_spine_in_primary_care_patients_with_low_back_pain:_randomised_controlled_trial_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=11179160 DB - PRIME DP - Unbound Medicine ER -