Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial

Objective To test the hypothesis that radiography of the lumbar spine inpat ients 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 recr uited 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, vis ual analogue scale for pain, health status, EuroQol, satisfaction with care , use of primary and secondary care services, and reporting of low back pai n at three and nine months after randomisation. Results The intervention roup were more likely to report low back pain at t hree 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 pa in scores. A higher proportion of participants consulted their doctor in th e three months after radiography (1.62, 1.33 to 1.97). Satisfaction wit car e was greater in the group receiving radiography at nine but not three mont hs after randomisation. Overall, 80% of participants in both groups at thre e and nine months would have radiography if the choice was available. Abnor mal finding on radiography made no difference to the outcome, as measured b y the Roland score. Conclusions Radiography of the lumbar spine in primary care patients with l ow back pain of at least six weeks' duration is not associated with improve d patient functioning severity of pain, or overall health status but is ass ociated with an increase in doctor workload. Guidelines on the management o f low back pain in primary care should be consistent about not recommending radiography of the lumber spine in patients with low back pain in the abse nce 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 satis faction without recourse to radiography.