Intended for healthcare professionals

Rapid response to:

General Practice

Outcome of low back pain in general practice: a prospective study

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7141.1356 (Published 02 May 1998) Cite this as: BMJ 1998;316:1356

Rapid Response:

Non attendance and morbidity from low back pain.

Dear Sir

The prospective study of low back pain (LBP) in general practice by Croft et al. reminds us of the important fact that non attendance for further care does not equal recovery. They measure morbidity which often remains unrecognised, and their data counter the claim that 90% of patients with LBP have fully recovered by one month.

However, this study is not methodologically robust enough to support the statement that of the non attenders 'most will still be experiencing low back pain and related disability one year after the (index) consultation'. Detailed follow up data analysing patients' experience outside the surgery was only available in a minority of the original group, 170/463 (37%), leaving considerable room for selection bias. Although an attempt was made to quantify this bias, the 'validation group' was too small (44) to be conclusive. Two further factors may have exagerated this bias. Both the original cross sectional survey and the interview process may have altered patients perceptions of their LBP (the Hawthorne effect).

Competing interests: No competing interests

12 May 1998
Alastair Hay
Clinical Lecturer in General Practice
University of Leicester, Leicester General Hospital, Gwendolen Rd, Leicester, LE5 4PW