Acute Back Syndrome--A Study from General Practice

Abstract

G. KALTON,t M.SC.(ECON.)Brit. med. J., 1966, 2, 82-84 Akhough the acute back syndrome, lumbago, or acute lower backache is such a common problem in general practice and an important cause of industrial disability (Troup, 1965), little discussion of it is given in the standard textbooks of orthopaedics. As the aetiology, pathology, and prognosis are all obscure, this lack of attention is understandable. To many minds acute lower back pain, with or without sciatica, suggests as a first possibility prolapsed lumbar intervertebral disc; to others the "osteopathic lesion" is the common explanation (Stoddard, 1959). This paper represents an attempt to measure the incidence of " acute backs " in one general practice and to note if a cause such as back strain is often present. An effort has also been made to discover if any aspects of the clinical condition have a significant influence on the duration of the initial attack or the liability to recurrence. MethodsThe population studied comprised all the patients of a suburban general practice in South-east London. A 10 % sample of patients in 1961 showed that the majority were middle-class: in fact only 11.5% of the 191 economically active and retired males in the sample were in the RegistrarGeneral's Social Classes IV and V (General Register Office, 1960), while in England and Wales generally the proportion is about two and a half times as large.In addition to comprehensive clinical records punched cards (Cope-Chat) were kept for each patient. On these cards a 12-months record of a patient's morbidity experience under broad diagnostic categories was kept, a new card being introduced at the beginning of each calendar year. In preparation for this study one position on the card was reserved for recording whether the patient suffered an attack of the acute back syndrome, which was defined as a sudden low backache severe enough for the patient to seek medical advice. While an analysis of the Cope-Chat cards included all cases of acute lower backache seen during the period of study, only the N.H.S. records of those patients still on the practice list were available for analysis.The results are presented in two parts. First, the incidence study was conducted by observing all the attacks recorded on the Cope-Chat cards during the four calendar years 1957-60, with an annually maintained age-sex register providing the basic information of the patients exposed to risk. The incidence study thus located all the patients who had experienced backache during 1957-60. Secondly, the follow-up study was concerned only with those patients who had experienced an attack of acute backache in the incidence study and who were still in the practice at the time of analysis (January 1965) ; for these patients the more detailed clinical information on the N.H.S. records was available. All such patients were followed up for a period of four years from the onset of their first attack in the incidence study, to observe whether they experienced any further attacks. (General Register Officer, 1954)...

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