United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care

doi:10.1136/bmj.38282.669225.AE

BMJ 2004;329:1377 (11 December), doi:10.1136/bmj.38282.669225.AE (published 19 November 2004)

Primary care

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care

UK BEAM Trial Team

Correspondence to: Martin Underwood, professor of general practice, Centre for General Practice and Primary Care, Institute of Community Health Sciences, Barts and the London, Queen Mary's School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS m.underwood{at}qmul.ac.uk

Objective To estimate the effect of adding exercise classes,spinal manipulation delivered in NHS or private premises, ormanipulation followed by exercise to "best care" in generalpractice for patients consulting with back pain.

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Fig 1 Progress of the UK BEAM trial

Design Pragmatic randomised trial with factorial design.

Setting 181 general practices in Medical Research Council GeneralPractice Research Framework; 63 community settings around 14centres across the United Kingdom.

Participants 1334 patients consulting their general practicesabout low back pain.

Main outcome measures Scores on the Roland Morris disabilityquestionnaire at three and 12 months, adjusted for centre andbaseline scores.

Results All groups improved over time. Exercise improved meandisability questionnaire scores at three months by 1.4 (95%confidence interval 0.6 to 2.1) more than "best care." For manipulationthe additional improvement was 1.6 (0.8 to 2.3) at three monthsand 1.0 (0.2 to 1.8) at 12 months. For manipulation followedby exercise the additional improvement was 1.9 (1.2 to 2.6)at three months and 1.3 (0.5 to 2.1) at 12 months. No significantdifferences in outcome occurred between manipulation in NHSpremises and in private premises. No serious adverse eventsoccurred.

Conclusions Relative to "best care" in general practice, manipulationfollowed by exercise achieved a moderate benefit at three monthsand a small benefit at 12 months; spinal manipulation achieveda small to moderate benefit at three months and a small benefitat 12 months; and exercise achieved a small benefit at threemonths but not 12 months.

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Rapid Responses:

Read all Rapid Responses

UK BEAM Trial Team: HC Faure
bmj.com, 23 Nov 2004 [Full text]
Which treatment for whom?: Dr Chris McCarthy
bmj.com, 3 Dec 2004 [Full text]
Comments on the BEAM Trial: Edzard Ernst
bmj.com, 6 Dec 2004 [Full text]
Re: Comments on the BEAM Trial: richard tillett MSc MCSP
bmj.com, 6 Dec 2004 [Full text]
Manipulation the panacea?: Philip Hope
bmj.com, 16 Dec 2004 [Full text]
Got back pain? Gravity could be your best friend!: Donald J. Stout
bmj.com, 29 Dec 2004 [Full text]
Does the UK BEAM trial really support the use of manipulation?: Francisco M Kovacs, et al.
bmj.com, 12 Jan 2005 [Full text]
An opportunity missed: John A Mathews
bmj.com, 31 Jan 2005 [Full text]
Is manipulation the most cost effective addition to �best care�?: Torill H. Tveito, et al.
bmj.com, 9 Feb 2005 [Full text]
Non-manipulative Relief for Chronic Back Pain: Arunachalam Kumar, et al.
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