BMJ 1996;312:1480 (8 June)

Letters

GPs' management of acute back pain

Is evidence based

EDITOR,--Paul Little and colleagues have examined the nature of the evidence underpinning clinical guidelines on the management of acute back pain in general practice and general practitioners' compliance with such guidelines.1 I take issue with both the authors' interpretation of the published evidence and the findings of their survey.

The authors are rather nihilistic about the generalisability to general practice of several of the good quality epidemiological studies. Gener-alisability is always a matter of judgment, but, as a practising general practitioner and clinical epidemiologist, I prefer to adopt the approach advocated by Glasziou and Irwig.2 They emphasise that generalisation that is too restrictive needs to be avoided and the question that should be asked is, "Are the patients in this study so different from my patients that I could not apply the study results?" Having used this question to examine the studies on back pain, I consider . . . [Full text of this article]


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Relevant Article

General practitioners' management of acute back pain: a survey of reported practice compared with clinical guidelines
Paul Little, Lisa Smith, Ted Cantrell, Judith Chapman, John Langridge, and Ruth Pickering
BMJ 1996 312: 485-488. [Abstract] [Full Text]

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