Abstract:
OBJECTIVE:To test the hypothesis that radiography of the lumbar spine in patients 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 recruited 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, visual analogue scale for pain, health status, EuroQol, satisfaction with care, use of primary and secondary care services, and reporting of low back pain at three and nine months after randomisation. RESULTS:The intervention group were more likely to report low back pain at three 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 pain scores. A higher proportion of participants consulted their doctor in the three months after radiography (1.62, 1.33 to 1.97). Satisfaction with care was greater in the group receiving radiography at nine but not three months after randomisation. Overall, 80% of participants in both groups at three and nine months would have radiography if the choice was available. An abnormal finding on radiography made no difference to the outcome, as measured by the Roland score. CONCLUSIONS:Radiography of the lumbar spine in primary care patients with low back pain of at least six weeks' duration is not associated with improved patient functioning, severity of pain, or overall health status but is associated with an increase in doctor workload. Guidelines on the management of low back pain in primary care should be consistent about not recommending radiography of the lumbar spine in patients with low back pain in the absence 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 satisfaction without recourse to radiography.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Kendrick D,Fielding K,Bentley E,Kerslake R,Miller P,Pringle Mdoi
10.1136/bmj.322.7283.400keywords:
subject
Has Abstractpub_date
2001-02-17 00:00:00pages
400-5issue
7283eissn
0959-8138issn
1756-1833journal_volume
322pub_type
临床试验,杂志文章,多中心研究,随机对照试验abstract:OBJECTIVE:To gain detailed understanding of influences on smoking behaviour in Bangladeshi and Pakistani communities in the United Kingdom to inform the development of effective and culturally acceptable smoking cessation interventions. DESIGN:Qualitative study using community participatory methods, purposeful samplin...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
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更新日期:2003-05-03 00:00:00
abstract::Physical examination of the cardiovascular system is central to contemporary teaching and practice in clinical medicine. Evidence about its value focuses on its diagnostic accuracy and varies widely in methodological quality and statistical power. This makes collation, analysis, and understanding of results difficult ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
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更新日期:2016-07-27 00:00:00
abstract:OBJECTIVE:To examine changes in immunisation performance in Grampian region after the introduction of the 1990 contract for general practitioners. DESIGN:Retrospective descriptive study using data held on the Grampian immunisation record system's computer. SETTING:All 95 general practices in Grampian region (313 gene...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6830.816
更新日期:1992-03-28 00:00:00
abstract:OBJECTIVE:To estimate the comparative clinical efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults. DESIGN:Systematic review with pairwise and network meta-analysis. DATA SOURCES:Electronic search of Embase, PubMed/Medline, and PsycINFO up to 8 M...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
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更新日期:2019-03-27 00:00:00
abstract:OBJECTIVES:To investigate the consequences of longstanding obesity on left ventricular mass and structure and to examine the effects of weight loss on these variables. DESIGN:Cross sectional survey and controlled intervention study. SETTING:City of Gothenburg and surrounding areas. Sweden. SUBJECTS:41 obese patients...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.315.7113.912
更新日期:1997-10-11 00:00:00
abstract::Cancer control encompasses the whole spectrum from prevention and early diagnosis to treatment and palliation. The key to the future of cancer control will be to establish multidisciplinary approaches to each type of cancer across this spectrum. For primary prevention this requires some understanding of the causes of ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.309.6952.449
更新日期:1994-08-13 00:00:00
abstract:OBJECTIVE:To evaluate the cost effectiveness of acupuncture in the management of chronic headache. DESIGN:Cost effectiveness analysis of a randomised controlled trial. SETTING:General practices in England and Wales. PARTICIPANTS:401 patients with chronic headache, predominantly migraine. Interventions Patients were ...
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pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38033.896505.EB
更新日期:2004-03-27 00:00:00
abstract:OBJECTIVES:To describe the menstrual experience of women referred for menstrual problems, in particular menorrhagia (excessive menstrual loss), and to assess associations with reasons for referral given by their general practitioners, the women's understanding of the reasons for their attendance at the hospital clinics...
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pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.323.7303.24
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abstract:OBJECTIVES:To assess the associations between both uric acid levels and hyperuricaemia, with ischaemic heart disease and blood pressure, and to explore the potentially confounding role of body mass index. DESIGN:Mendelian randomisation analysis, using variation at specific genes (SLC2A9 (rs7442295) as an instrument fo...
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pub_type: 杂志文章
doi:10.1136/bmj.f4262
更新日期:2013-07-18 00:00:00
abstract::The import of the HIV or AIDS epidemic for heterosexuals in Britain is difficult to evaluate at this stage. By June 1988, only 60 cases of heterosexually acquired AIDS are known, out of 1598 reported AIDS cases. Of these, only 6 women and 4 men presumably were infected in Britain, the rest abroad. But, judging from...
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更新日期:1989-02-18 00:00:00
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更新日期:2019-05-07 00:00:00
abstract:OBJECTIVE:To characterise the clinical features of patients admitted to hospital with coronavirus disease 2019 (covid-19) in the United Kingdom during the growth phase of the first wave of this outbreak who were enrolled in the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Hea...
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pub_type: 杂志文章
doi:10.1136/bmj.m1985
更新日期:2020-05-22 00:00:00
abstract:OBJECTIVE:To assess body shape trajectories in early and middle life in relation to risk of mortality. DESIGN:Prospective cohort study. SETTING:Nurses' Health Study and Health Professionals Follow-up Study. POPULATION:80 266 women and 36 622 men who recalled their body shape at ages 5, 10, 20, 30, and 40 years and p...
journal_title:BMJ (Clinical research ed.)
pub_type: 评论,杂志文章
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更新日期:2016-05-04 00:00:00
abstract:OBJECTIVE:To examine the relation between diameters of the retinal arterioles and 10 year incidence of hypertension. DESIGN:Population based prospective cohort study. SETTING:Beaver Dam eye study. PARTICIPANTS:2451 normotensive people aged 43 to 84 years. MAIN OUTCOME MEASURES:Diameters of retinal arterioles and ve...
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pub_type: 杂志文章
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更新日期:2004-07-10 00:00:00
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doi:10.1136/bmj.h2388
更新日期:2015-06-02 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f4240
更新日期:2013-07-23 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.38803.528113.55
更新日期:2006-05-20 00:00:00
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更新日期:2008-03-29 00:00:00
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journal_title:BMJ (Clinical research ed.)
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pub_type: 杂志文章
doi:10.1136/bmj.309.6947.98
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更新日期:2019-11-27 00:00:00
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pub_type: 杂志文章
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更新日期:2009-03-12 00:00:00
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更新日期:2013-04-18 00:00:00
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更新日期:1995-05-06 00:00:00
abstract:OBJECTIVE:To assess the effectiveness of health checks by nurses in reducing risk factors for cardiovascular disease in patients from general practice. DESIGN:Randomised controlled trial. SETTING:Five urban general practices in Bedfordshire. SUBJECTS:2136 patients receiving an initial health check in 1989-91 and sch...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1994-01-29 00:00:00
abstract:OBJECTIVES:To study the effects of metformin on the incidence of vitamin B-12 deficiency (<150 pmol/l), low concentrations of vitamin B-12 (150-220 pmol/l), and folate and homocysteine concentrations in patients with type 2 diabetes receiving treatment with insulin. DESIGN:Multicentre randomised placebo controlled tri...
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更新日期:2010-05-20 00:00:00
abstract:OBJECTIVE:To examine the predictors of long term outcome for patients with the chronic fatigue syndrome. DESIGN:Cohort study. SUBJECTS:139 subjects previously enrolled in two treatment trials; 103 (74%) were reassessed a mean of 3.2 years after start of the trials. SETTING:University hospital referral centre. MAIN ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.308.6931.756
更新日期:1994-03-19 00:00:00
abstract::Lifetime fertility, abortion rates, and the proportion of pregnancies resulting in induced abortion were investigated in 105 district health authorities in England. In 1995, a total of 147,851 abortions occurred among women living in England, compared with 613,257 live births; a ratio of 1:4. This was equivalent to ...
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pub_type: 杂志文章
doi:10.1136/bmj.316.7146.1711
更新日期:1998-06-06 00:00:00
abstract:OBJECTIVE:To compare the implications of four widely used cholesterol screening and treatment guidelines by applying them to a population in the United Kingdom. DESIGN:Guidelines were applied to population based data from a cross sectional study of cardiovascular disease and risk factors. SETTING:Newcastle upon Tyne,...
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doi:10.1136/bmj.317.7166.1125
更新日期:1998-10-24 00:00:00