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What is usual care for low back pain? A systematic review of health care provided to patients with low back pain in family practice and emergency departments
Abstract
International clinical practice guidelines for low back pain (LBP) contain consistent recommendations including universal provision of information and advice to remain active, discouraging routine referral for imaging, and limited prescription of opioids. This systematic review describes usual care provided by first-contact physicians to patients with LBP. Studies that reported the assessments and care provided to people with LBP in family practice and emergency departments (EDs) from January 2000 to May 2019 were identified by searches of PubMed, EMBASE, and CINAHL. Study quality was assessed with reference to representativeness of samples, potential misclassification of patients, potential misclassification of outcomes, inconsistent data and precision of the estimate, and the findings of high-quality studies were prioritized in the data synthesis. We included 26 studies that reported data from almost 195,000 patients: 18 from family practice, and 8 from EDs. Less than 20% of patients with LBP received evidence-based information and advice from their family practitioner. Around 1 in 4 patients with LBP received referral for imaging in family practice and 1 in 3 in EDs. Up to 30% of patients with LBP were prescribed opioids in family practice and up to 60% in EDs. Large numbers of patients who saw a physician for LBP received care that is inconsistent with evidence-based clinical practice guidelines. Usual care included overuse of imaging and opioid prescription and underuse of advice and information. Suboptimal care may contribute to the massive burden of the condition worldwide.
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“However, a systematic review of usual care for LBP has shown that the rate of referral to physiotherapy after consultation with a family practitioner is as low as 14% to 27%,113”
From Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis (2022) · cites this paper as [113]
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Metadata
- Authors
- Kamper, S. J., Logan, G., Copsey, B., Thompson, J., Machado, G. C., Abdel-Shaheed, C., Williams, C. M., Maher, C. G., & Hall, A. M.
- Affiliations
- The University of Sydney (AU)
- Memorial University of Newfoundland (CA)
- University of Oxford (GB)
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Australia
- Hunter New England Local Health District (AU)
- Corresponding author
- Kamper, Steven J.
- ORCID
- Venue
- Pain
- Published
- 2019-11-14
- Volume
- 161
- Issue
- 4
- Pages
- 694-702
- ISSN
- 0304-3959 (ISSN-L)
- 1872-6623
- OpenAlex
- W2983434735
- Cited by
- 196
- References
- 55
- Citations by year
- 2026: 20 · 2025: 27 · 2024: 26 · 2023: 39 · 2022: 47 · 2021: 26 · 2020: 10 · 2019: 1
- FWCI
- 2.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- low back pain, usual care, general practice, emergency department, guideline adherence, imaging referral, opioid prescribing, first contact care, overuse of imaging
- MeSH terms
- Analgesics, Opioid, Delivery of Health Care, Emergency Service, Hospital, Family Practice, Humans, Low Back Pain
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