Low Back Pain in Primary Care: Effectiveness of Diagnostic and Therapeutic Interventions.

van Tulder MW, Koes BW, Bouter LM, eds. Amsterdam, the Netherlands, Faculteit der Geneeskunde, Vrije Universiteit, EMGO Institute, 1996, paperback, 285 pp, illus, $37.

This book is a comprehensive review and critical analysis of the efficacy of diagnosing and treating patients with low back pain in primary care. The Dutch Medical Insurance Board subsidized the study, which was conducted at the Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the Netherlands. Fifteen authors contributed to the report.

This book consists of 16 chapters. The first 4 chapters deal with costs and current practice styles in the primary care setting in the Netherlands. Two chapters report on the reliability and validity of the Dutch adaptations to both the Quebec Back Pain Disability Scale and the Roland-Morris Questionnaire.

The remaining chapters deal with systematic reviews of diagnostic tests and multiple therapeutic interventions. Each of the systematic reviews is based on the same methodological criteria. This approach not only serves to assist the reader in evaluating the results but also provides good methodological guidelines for future research.

The accuracies of the history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain and the value of spinal radiographs for nonspecific low back pain are reviewed in chapters 7 and 8.

The efficacy of epidural steroid injections, bed rest and orthoses, back schools, spinal manipulation and mobilization, and nonsteroidal antiinflammatory drugs is covered in chapters 9 through 13 by systematically reviewing randomized clinical trials.

The overall methodological quality of randomized clinical trials for the treatment of patients with low back pain is scrutinized in chapter 14. Chapters 15 and 16 provide a systematic metareview of 81 randomized clinical trials of 11 different interventions for the conservative treatment of patients with acute low back pain and 14 different interventions in 80 randomized clinical trials to assess conservative treatments for patients with chronic low back pain. A comprehensive summary and recommendations section is included. The need for future research in methodology, intervention, guideline development, prognostic indicators, and prevention is emphasized.

This book serves as an excellent resource for any physical therapist or physician involved in research, physician education, or treatment of patients with low back pain. The book is well referenced, which allows the reader the opportunity to examine any of the published articles in detail. The chapters are organized and presented so that the reader can easily identify and read about a particular subject of interest.

Jeff Yaver, PT
Kaiser Permanente
Rancho Cordova, Calif

Mr Yaver is Clinic Coordinator for an outpatient clinic. He treats and manages patients with musculoskeletal dysfunctions using manual therapy, education, and exercise.