BMJ 1999;319:279-283 ( 31 July )

Papers

Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences

Jennifer Klaber Moffett, research fellow, ^a David Torgerson, research fellow, ^a Sally Bell-Syer, research fellow, ^a David Jackson, research fellow, ^a Hugh Llewlyn-Phillips, research fellow, ^a Amanda Farrin, trial statistician, ^b Julie Barber, research fellow in medical statistics. ^c

^a Centre for Health Economics, University of York, York, ^b Department of Health Sciences and Clinical Evaluation, University of York, ^c Department of Medical Statistics and Evaluation, Imperial College School of Medicine, University of London

Correspondence to: J Klaber Moffett, Institute of Rehabilitation, University of Hull, Hull HU3 2PG j.a.moffett{at}medschool.hull.ac.uk

Objective: To evaluate effectiveness of an exercise programme in a community setting for patients with low back pain to encourage a return to normal activities.
Design: Randomised controlled trial of progressive exercise programme compared with usual primary care management. Patients' preferences for type of management were elicited independently of randomisation.
Participants: 187 patients aged 18-60 years with mechanical low back pain of 4 weeks to 6 months' duration.
Interventions: Exercise classes led by a physiotherapist that included strengthening exercises for all main muscle groups, stretching exercises, relaxation session, and brief education on back care. A cognitive-behavioural approach was used.
Main outcome measures: Assessments of debilitating effects of back pain before and after intervention and at 6 months and 1 year later. Measures included Roland disability questionnaire, Aberdeen back pain scale, pain diaries, and use of healthcare services.
Results: At 6 weeks after randomisation, the intervention group improved marginally more than the control group on the disability questionnaire and reported less distressing pain. At 6 months and 1 year, the intervention group showed significantly greater improvement in the disability questionnaire score (mean difference in changes 1.35, 95% confidence interval 0.13 to 2.57). At 1 year, the intervention group also showed significantly greater improvement in the Aberdeen back pain scale (4.44, 1.01 to 7.87) and reported only 378 days off work compared with 607 in the control group. The intervention group used fewer healthcare resources. Outcome was not influenced by patients' preferences.
Conclusions: The exercise class was more clinically effective than traditional general practitioner management, regardless of patient preference, and was cost effective.

Key messages Patients with back pain need to return to normal activities as soon as possible but are often afraid that movement or activity may be harmful An exercise programme led by a physiotherapist in the community and based on cognitive-behavioural principles helped patients to cope better with their pain and function better even one year later Patients' preferences for type of management did not affect outcome Patients in the intervention group tended to use fewer healthcare resources and took fewer days off work This type of exercise programme should be more widely available

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© BMJ 1999

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