COMMUNITY STUDIES OF THE HEALTH-SERVICE IMPLICATIONS OF LOW-BACK-PAIN

Study Design. Retrospective study using primary care physician case no tes and a self-report questionnaire on the same randomly selected popu lation sample. Objectives. To assess the prevalence, management, and o utcomes of low back pain in the community, comparing, in the same rand om sample of registered patients, self-report questionnaire data and p rimary care physicians' records. Summary of Background Data. The finan cial and resource implications of low back pain are extensive. Data on consultations, investigations, and the management of low back pain ar e fragmentary and there are no comparisons estimating prevalence from case notes and serf-report. Methods. A retrospective study of prevalen ce, management, referral, and outcome covering the previous 12 months was carried out in three general practices using case notes and a self -report postal questionnaire on a sample of 900 patients over 18 years . Results. Lifetime prevalence of low back pain was 62%. Annual preval ence was 48%, with 16% reporting low back pain at the time of report. Twenty-four percent consulted their primary care physician for low bac k pain, of whom 17% were referred to a hospital specialist. The annual consultation rate of patients with low back pain was similar to the r ate for patients with chronic conditions. The activities of daily livi ng were restricted in less than half, with few taking sick leave. The general health status of those reporting recent low back pain was sign ificantly lower than those not reporting low back pain. Most felt that low back pain was self-limiting and would not consult health professi onals for future episodes. There were substantial discrepancies betwee n case notes recorded at consultation with the primary care physician and self-report regarding consultation and investigations. Conclusions . Prevalence rates were comparable with those reported in other studie s. The significant discrepancies between data sources suggest patient recall bias or underrecording in case notes. The low consultation rate , time off, and day-to-day disability indicate that most episodes are self-limiting.