[Evaluating the appropriateness of low back pain care]

Physicians must insure that care provided--whether it be preventive, diagnostic, therapeutic of palliative--is appropriate. Confronted with the swift development of medical progress and the tremendous quantity and uneven quality of available information on appropriateness of care, it is important to determine optimal strategies for identifying necessary, relevant and valid information in this respect. Medical care is considered appropriate if the expected benefits to the patient outweigh the potential risks. The ideal source of information concerning appropriateness of care stems from rigorously conducted, randomized, controlled trials and from systematic reviews of the literature, such as those prepared by the Cochrane Collaboration. Concerning treatment of low back pain, recent years have witnessed several groups active in preparing such rigorous systematic reviews. Different sources of information on appropriateness of care for back pain are presented in this article. Unfortunately, many reviews underline the absence of evidence for the effectiveness of most treatments now used in the treatment of low back pain. On the other hand, absence of proof of effectiveness, and, as often in medicine, elements other than the quality of evidence must enter into the decision to use or not to use various treatments. But this should not keep us from pursuing rigorous clinic research to improve the scientific basis of care provided to our patients suffering from low back pain.