I like to treat the back the same as the front. Almost like a two sided quilt. I did make my parents photos quilts with plain backing but other than that I find a way to incorporate something of the front to the back.

I dont worry about where the quilting falls. I just quilt for the front and let the back be whatever it turns out to be

Of course I have not made very many quilts yet,so I may change these ways as I learn more. You never know