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Radiography for low back pain: a randomised controlled trial and observational study in primary care.
Br J Gen Pract. 2002 Jun; 52(479):469-74.BJ

Abstract

BACKGROUND

Lumbar spine radiography has limited use in diagnosing the cause of acute low back pain. Consensus-based guidelines recommend that lumbar spine x-rays are not used routinely. However there have been no studies of the effect of referral for radiography at first presentation with low back pain in primary care.

AIM

To compare short and long-term physical, social, and psychiatric outcomes for patients with low back pain who are referred or not referred for lumbar spine x-ray at first presentation in general practice.

DESIGN OF STUDY

A randomised unblinded controlled trial with an observational arm to enable comparisons to be made with patients not recruited to the trial.

SETTING

Ninety-four general practices in south London and the South Thames region.

METHOD

Patients consulting their general practitioner (GP) with low back pain at first presentation were recruited to a randomised controlled trial (RCT) or to an observational group. Patients in the trial were randomly allocated to immediate referral for x-ray or to no referral. All patients were asked to complete questionnaires initially, and then at six weeks and one year after recruitment.

RESULTS

Six hundred and fifty-nine patients were recruited over 26 months: 153 to the randomised trial and 506 to the observational arm. In the RCT referral for x-ray had no effect on physical functioning, pain or disability, but was associated with a small improvement in psychological wellbeing at six weeks and one year. These findings were supported by the observational study in which there were no differences between the groups in physical outcomes after adjusting for length of episode at presentation; however, those referred for x-ray had lower depression scores.

CONCLUSIONS

Referral for lumbar spine radiography for first presentation of low back pain in primary care is not associated with improved physical functioning, pain or disability. The possibility of minor psychological improvement should be balanced against the high radiation dose involved.

Authors+Show Affiliations

Department of General Practice and Primary Care, St George's Hospital Medical School, London. sgjdgp2@sghms.ac.ukNo 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

12051211

Citation

Kerry, Sally, et al. "Radiography for Low Back Pain: a Randomised Controlled Trial and Observational Study in Primary Care." The British Journal of General Practice : the Journal of the Royal College of General Practitioners, vol. 52, no. 479, 2002, pp. 469-74.
Kerry S, Hilton S, Dundas D, et al. Radiography for low back pain: a randomised controlled trial and observational study in primary care. Br J Gen Pract. 2002;52(479):469-74.
Kerry, S., Hilton, S., Dundas, D., Rink, E., & Oakeshott, P. (2002). Radiography for low back pain: a randomised controlled trial and observational study in primary care. The British Journal of General Practice : the Journal of the Royal College of General Practitioners, 52(479), 469-74.
Kerry S, et al. Radiography for Low Back Pain: a Randomised Controlled Trial and Observational Study in Primary Care. Br J Gen Pract. 2002;52(479):469-74. PubMed PMID: 12051211.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radiography for low back pain: a randomised controlled trial and observational study in primary care. AU - Kerry,Sally, AU - Hilton,Sean, AU - Dundas,Derek, AU - Rink,Elizabeth, AU - Oakeshott,Pippa, PY - 2002/6/8/pubmed PY - 2002/7/13/medline PY - 2002/6/8/entrez SP - 469 EP - 74 JF - The British journal of general practice : the journal of the Royal College of General Practitioners JO - Br J Gen Pract VL - 52 IS - 479 N2 - BACKGROUND: Lumbar spine radiography has limited use in diagnosing the cause of acute low back pain. Consensus-based guidelines recommend that lumbar spine x-rays are not used routinely. However there have been no studies of the effect of referral for radiography at first presentation with low back pain in primary care. AIM: To compare short and long-term physical, social, and psychiatric outcomes for patients with low back pain who are referred or not referred for lumbar spine x-ray at first presentation in general practice. DESIGN OF STUDY: A randomised unblinded controlled trial with an observational arm to enable comparisons to be made with patients not recruited to the trial. SETTING: Ninety-four general practices in south London and the South Thames region. METHOD: Patients consulting their general practitioner (GP) with low back pain at first presentation were recruited to a randomised controlled trial (RCT) or to an observational group. Patients in the trial were randomly allocated to immediate referral for x-ray or to no referral. All patients were asked to complete questionnaires initially, and then at six weeks and one year after recruitment. RESULTS: Six hundred and fifty-nine patients were recruited over 26 months: 153 to the randomised trial and 506 to the observational arm. In the RCT referral for x-ray had no effect on physical functioning, pain or disability, but was associated with a small improvement in psychological wellbeing at six weeks and one year. These findings were supported by the observational study in which there were no differences between the groups in physical outcomes after adjusting for length of episode at presentation; however, those referred for x-ray had lower depression scores. CONCLUSIONS: Referral for lumbar spine radiography for first presentation of low back pain in primary care is not associated with improved physical functioning, pain or disability. The possibility of minor psychological improvement should be balanced against the high radiation dose involved. SN - 0960-1643 UR - https://www.unboundmedicine.com/medline/citation/12051211/Radiography_for_low_back_pain:_a_randomised_controlled_trial_and_observational_study_in_primary_care_ L2 - https://bjgp.org/cgi/pmidlookup?view=long&pmid=12051211 DB - PRIME DP - Unbound Medicine ER -