Randomised controlled trial of physiotherapy compared with advice for low back pain

doi:10.1136/bmj.38216.868808.7C

BMJ 2004;329:708 (25 September), doi:10.1136/bmj.38216.868808.7C (published 17 September 2004)

Paper

Randomised controlled trial of physiotherapy compared with advice for low back pain

Helen Frost, research fellow¹, Sarah E Lamb, professor of rehabilitation¹, Helen A Doll, medical statistician², Patricia Taffe Carver, trial coordinator³, Sarah Stewart-Brown, professor of public health¹

¹ Division of Health in the Community, Warwick Medical School, University of Warwick, Warwick CV4 7AL, ² Health Services Research Unit, Department of Public Health, University of Oxford, ³ Nuffield Orthopaedic Centre NHS Trust, Oxford

Correspondence to: H Frost h.frost.1{at}warwick.ac.uk

Objective To measure the effectiveness of routine physiotherapycompared with an assessment session and advice from a physiotherapistfor patients with low back pain.

Design Pragmatic, multicentre, randomised controlled trial.

Setting Seven British NHS physiotherapy departments.

Participants 286 patients with low back pain of more than sixweeks' duration.

Intervention Routine physiotherapy or advice on remaining activefrom a physiotherapist. Both groups received an advice book.

Main outcome measures Primary outcome was scores on the Oswestrydisability index at 12 months. Secondary outcomes were scoreson the Oswestry disability index (two and six months), scoreson the Roland and Morris disability questionnaire and SF-36(2, 6 and 12 months), and patient perceived benefit from treatment(2, 6, and 12 months).

Results 200 of 286 patients (70%) provided follow up informationat 12 months. Patients in the therapy group reported enhancedperceptions of benefit, but there was no evidence of a longterm effect of physiotherapy in either disease specific or genericoutcome measures (mean difference in change in Oswestry disabilityindex scores at 12 months -1.0%, 95% confidence interval -3.7%to 1.6%). The most common treatments were low velocity spinaljoint mobilisation techniques (72%, 104 of 144 patients) andlumbar spine mobility and abdominal strengthening exercises(94%, 136 patients).

Conclusions Routine physiotherapy seemed to be no more effectivethan one session of assessment and advice from a physiotherapist.

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Rapid Responses:

Read all Rapid Responses

Ooooops, is most treatment unnecessary intervention?: Dr. Herbert H. Nehrlich
bmj.com, 25 Sep 2004 [Full text]
What about the early benefits of physiotherapy?: Roderick D D Duncan
bmj.com, 25 Sep 2004 [Full text]
NHS physiotherapy systems will not prevent back pain disability: Jeremy G Jones
bmj.com, 25 Sep 2004 [Full text]
Nothing new, but what really are the mechanisms of back-pain?: Jarkko O. Kause,DC
bmj.com, 28 Sep 2004 [Full text]
Important information missing from the published article: Garth Robertson
bmj.com, 27 Sep 2004 [Full text]
Good advice is often the best treatment: jon norman
bmj.com, 27 Sep 2004 [Full text]
RAPID ACCESS TO PHYSIOTHERAPY: Christopher W IDE
bmj.com, 27 Sep 2004 [Full text]
Answer - Refer to Chiropractors: Glenn F. Gumaer
bmj.com, 27 Sep 2004 [Full text]
Evidence in the making: Saravana Kumar
bmj.com, 27 Sep 2004 [Full text]
Don't throw the baby out with the hydrotherapy!: Rajashekhar M. Reddy, et al.
bmj.com, 27 Sep 2004 [Full text]
Re: Answer - Refer to Chiropractors: Mark Potter
bmj.com, 27 Sep 2004 [Full text]
"Physiotherapy better to be talked about than not at all": Malcolm J Philp
bmj.com, 27 Sep 2004 [Full text]
Magnesium deficiency as a cause of back pain: Ellen C G Grant
bmj.com, 28 Sep 2004 [Full text]
Be careful what you infer: Michael Poling
bmj.com, 30 Sep 2004 [Full text]
A complete wash out.: Dr Christopher J McCarthy
bmj.com, 28 Sep 2004 [Full text]
What a shame!: John A Mathews
bmj.com, 28 Sep 2004 [Full text]
Outcome of physiotherapy, a true reflection of heterogenous data!: Kevin K Wright
bmj.com, 28 Sep 2004 [Full text]
Finer measures are required to determine the efficacy of physiotherapy: Venthan J Mailoo
bmj.com, 28 Sep 2004 [Full text]
Re: Re: Answer - Refer to Chiropractors: Dr. Glenn F. Gumaer
bmj.com, 28 Sep 2004 [Full text]
Magnesium is a SUPERNUTRIENT: Dr. Herbert H. Nehrlich
bmj.com, 29 Sep 2004 [Full text]
Good News for Physiotherapists?: David A Jackson
bmj.com, 29 Sep 2004 [Full text]
Comparing One Session of Physiotherapy Management Wth Several?: Mary Louise Taylor
bmj.com, 29 Sep 2004 [Full text]
Chiropractic biscuits: Richard Bartley
bmj.com, 29 Sep 2004 [Full text]
Physios can't cure CHRONIC low back pain.: Dan Doherty
bmj.com, 29 Sep 2004 [Full text]
GP-Physio-Team -Methinks we can do better: Dr. Herbert H. Nehrlich
bmj.com, 29 Sep 2004 [Full text]
Good study, wrong conclusion: Alfonso Ceccherini-Nelli
bmj.com, 29 Sep 2004 [Full text]
Re: Chiropractic biscuits: Jarkko O. Kause,DC
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Faster and better results experienced by people who received more physiotherapy: Maria G. Judd
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Misleading title biases interpretation: J. Haxby Abbott, et al.
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Manage or cure?: Christopher Stuart, DC
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Re: Good study, wrong conclusion: Dr. Herbert H. Nehrlich
bmj.com, 29 Sep 2004 [Full text]
Physiotherapy for Back Pain: Malcolm IV Jayson
bmj.com, 30 Sep 2004 [Full text]
Re: Answer - Refer to Chiropractors: Richard J Nash
bmj.com, 30 Sep 2004 [Full text]
Here, have some back treatment - cheers!: adrian wagstaff
bmj.com, 30 Sep 2004 [Full text]
Back pain patients and Psychobabble.: Christopher Stuart, DC
bmj.com, 30 Sep 2004 [Full text]
Re: Re: Answer - Refer to Chiropractors: James M. Reynaud
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Chiropractic v Physiotherapy: Peter J Ward
bmj.com, 1 Oct 2004 [Full text]
More chiropractic biscuits: Richard Bartley
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Is Physiotherapy effective for the management of LBP?: Fraser Ferguson, et al.
bmj.com, 1 Oct 2004 [Full text]
Treat Underlying Aetiology: Nick D Critchley
bmj.com, 1 Oct 2004 [Full text]
Reply to Nash, Ward: Dr. Glenn F. Gumaer
bmj.com, 2 Oct 2004 [Full text]
Move on: Martin Jones
bmj.com, 3 Oct 2004 [Full text]
Re: Last chiropractic biscuits: Jarkko O. Kause,DC
bmj.com, 3 Oct 2004 [Full text]
Politically acceptable research results ?: Tom A Torstensen, B.Sc (Hons), M.Sc., P.T., specialist in manipulative therapy, M.N.F.F.
bmj.com, 4 Oct 2004 [Full text]
Chiropractic & Osteopathy: Corey Watts
bmj.com, 4 Oct 2004 [Full text]
Alas further confounding appraisal: Brian Sweetnam
bmj.com, 7 Oct 2004 [Full text]
Don't dismiss physiotherapy: Neil Watson
bmj.com, 12 Oct 2004 [Full text]
A theory that is refutable can still be charming: Dr. Herbert H. Nehrlich
bmj.com, 13 Oct 2004 [Full text]
Publishing responsibilities: Neil Watson
bmj.com, 14 Oct 2004 [Full text]
Acupuncture for treatment of low back pain: Janet Boaler
bmj.com, 15 Oct 2004 [Full text]
Good assessment and advice by a physiotherapist is as effective as traditional physiotherapy.: Abdolkarim Karimi
bmj.com, 15 Oct 2004 [Full text]
Back pain treatment is anything but patient centred!: Murray Flett
bmj.com, 18 Oct 2004 [Full text]
Low Back Pain and Physiotherapy: Friederike I.M. von Rabenau
bmj.com, 23 Oct 2004 [Full text]
Targeting �physical factors� alone is not evidence-based practice: Maureen Simmonds, et al.
bmj.com, 16 Nov 2004 [Full text]
Important Oversight: Tom Caumont
bmj.com, 9 Dec 2004 [Full text]
Physiotherapy and low back pain: Meir Lotan, et al.
bmj.com, 23 Dec 2004 [Full text]
Proper Title: Trial of NHS Physiotherapy compared with advice for LBP: Brad S Stevens
bmj.com, 10 Oct 2005 [Full text]