management of low back pain in primary care

Physiotherapy September 2003/vol 89/no 9

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Book reviews

Butterworth-Heinemann, Oxford2001 (ISBN 0 7506 4787 6). 193 pages

by Richard Bartley and P Coffey £23This book is aimed at general practitioners and healthcareprofessionals treating lower back pain in the primary caresector. The book is based on the Royal College of GeneralPractitioners guidelines and is a compilation of evidence-based literature reviews from the multiple disciplinesinvolved in the management of lower back pain. It is notdesigned to be read from cover to cover but rather as 17chapters of reference material. It is not a recipe book of how to treat lower back pain but does however give optionsand routes for practitioners to consider where to go withinthe multi-disciplinary teams. One of the strong themesthroughout the book is the attempt to provide evidence for a correct and suitable referral to a consultant, whileretaining the single largest cause of time off work in theprimary care sector.

The 17 chapters have been divided into six sectionsfollowing Royal College of General Practitioners guidelines:

Section 1 ‘Background’ gives the usual statistics, asummary of the Royal College of General Practitionersguidelines, yellow flags and practical advice whenassessing/triaging patients.

Sections 2, 3 and 4 follow the Royal College of GeneralPractitioners sub-classifications of lower back pain, simple

back pain, nerve root pain and suspected serious pathologyrespectively. I found the chapter on spinal stenosis help-ful for the differential diagnosis, while the chapter onneoplasms of the spine increases awareness of those rarepatients with progressive symptoms.

Section 5 gives good clear advice on requesting radio-logical and laboratory investigations.

The sixth and final section discusses the management oflower back pain with regard to drug therapy, surgery andphysical therapy (encompassing physiotherapists, osteopathsand chiropractors). As mentioned earlier this is not a recipebook and these final chapters offer concise information as towhat is available, but not how to treat.

An epilogue provides an interesting insight into theproblems experienced with implementing the Royal Collegeof General Practitioners guidelines. It explains thebackground to the introduction of the guidelines and whythey have not been totally successful. The epilogueconcludes with a short section on strategies of how toimplement the guidelines in general practice.

In conclusion I believe that this book has a great deal ofsound practical advice with the grounding of recentlyresearched material, which in its own right has been usedextensively. It is certainly an excellent reference source forany practitioner or department dealing with spinalproblems.

I found it easy reading with references that would bevaluable for further research, should you wish to explore adifficult case.

Robert Alexander MCSP

Management of Low Back Painin Primary Care

Open University Press, Maidenhead2002 (ISBN 0 335 20718 9). 290 pages

by Rowena Murray £17This is a comprehensive text on how to go about writing athesis, geared primarily towards doctoral students andsupervisors. However, many of the principles are applicableto writing at all levels from BSc project reports through topapers for academic journals.

The book deals with many aspects of writing, includinginitiating and formalising ideas, how to plan and structurethe thesis, motivation for writing, and developing strategiesto ensure that writers complete their work.

The text leads writers through the process of initialplanning, the research proposal and developing the first-year report. The author suggests the formation of ‘writers’

groups’ to provide peer support and to allow members toshare and solve problems encountered when writing theses.

The book covers many divergent themes and is sometimeshard to navigate. This may be because it addressesconceptual issues which do not fall along a structure time-line. However, familiarity with the text will allow readersgreater ease of access to relevant sections.

Strategies for dealing with writer’s block and the inevitablefrustration that accompanies the revising process arediscussed.

Finally the book discusses vivas and further writing that isoften required afterwards.

At each stage, boxed inserts allow writers to question andcross-check that they have addressed the major themes andconventions.

In summary, this is a useful resource for those wishing todevelop clear writing skills.

Michèle Harms PhD MSc MCSP

How to Write a Thesis