Low Back Pain in Primary Care

Abstract

Low Back Pain in Primary Care Effectiveness of diagnostics and therapeutic interventions edited by Maurits M van Tulder, Bart W Koes and Lex M Bouter. Institute for Research in Extramural Medicine, Faculty of Medicine, Vrije Universiteit, van der Boechorststraat 7, 1081 BTAmsterdam, 1996 (ISBN 90 5669 01 1 6). 285 pages. FI 100. This book is the result of a series of studies funded by the Dutch Medical Insurance Board examining the cost, effectiveness and validity of current research into diagnostics and interventions of low back pain (LBP) in primary care in the Netherlands. This began in 1992 with 15 authors. All the reviewed publications are of good quality and up to date. The authors clearly state that they have limited their searches of the literature to those available on the databases which may have led to the exclusion of some very relevant literature. Also, they limited the literature t o works published in English and avoided literature where either the key words or abstracts made the subject content unclear. The book is divided into five sections: cost of LBP, management of LBP in general practice, assessment of functional status of patients with LBP, value of diagnostic tests, and efficacy of various therapeutic interventions for LBP. There is a good summary of the book’s main results a t the start which is helpful. The subsequent chapters cover clearly and extensively solid reviews of the literature questioning the very basis of current management of LBP in the Netherlands. There are plenty of parallels for us in the UK and worldwide. The authors have covered a wide range of diagnostic and therapeutic parameters including our own ministrations. When the bulk of the information is broken down, the authors conclude that acute LBP management is best dealt with by supplying patients with good information and advice, anti-inflammatory medication, and muscle relaxants, and there is little place for manual therapy; whereas in management of the chronic condition the key thrust is re-activation of the patient, manipulation and exercises. Despite the authors referencing the two recent key publications by the Clinical Standards Advisory Group and the subsequent audit within this book’s text there is some discrepancy with the CSAG/GP’s audit findings, notably that the CSAG/GP’s audit suggests the use of manipulation as being valuable in the management of acute LBP. Perhaps this serves to demonstrate the many deficiencies available in current research. I found the layout of the book easy to follow and it will be a very valuable text for all manual therapists of whatever persuasion and an essential text for undergraduate libraries. Alan Leigh MSc(Manip Ther) MCSP GMT(NZ) MACP