BMJ  2005;330:75 (8 January), doi:10.1136/bmj.38286.493206.82 (published 7 December 2004)

Primary care

Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients' preference

¹ Institute of Rehabilitation, University of Hull, Hull HU3 2PG, ² Department of Public Health and Primary Care, University of Hull, Hull HU6 7RX, ³ Department of Health Sciences, University of York, York YO10 5DD, ⁴ Centre for Health Economics, University of York

Objectives Firstly, to compare the effectiveness of a brief physiotherapy intervention with "usual" physiotherapy for patients with neck pain. Secondly, to evaluate the effect of patients' preferences on outcome.

Design Non-inferiority randomised controlled trial eliciting preferences independently of randomisation.

Setting Physiotherapy departments in a community setting in Yorkshire and north Lincolnshire.

Participants 268 patients (mean age 48 years) with subacute and chronic neck pain, who were referred by their general practitioner and randomly assigned to a brief physiotherapy intervention (one to three sessions) using cognitive behaviour principles to encourage self management and return to normal function or usual physiotherapy, at the discretion of the physiotherapist concerned.

Main outcome measures The Northwick Park neck pain questionnaire (NPQ), a specific measure of functional disability resulting from neck pain. Also, the short form 36 (SF-36) questionnaire, a generic, health related, quality of life measure; and the Tampa scale for kinesophobia, a measure of fear and avoidance of movement.

Results At 12 months, patients allocated to usual physiotherapy had a small but significant improvement in NPQ scores compared with patients in the brief intervention group (mean difference 1.99, 95% confidence interval 0.45 to 3.52; P = 0.01). Although the result shows a significant inferiority of the intervention, the confidence interval shows that the effect could be in the non-inferiority range for the brief intervention (below 1.2 points of NPQ score). Patients who preferred the brief intervention and received this treatment had similar outcomes to patients receiving usual physiotherapy.

Conclusions Usual physiotherapy may be only marginally better than a brief physiotherapy intervention for neck pain. Patients with a preference for the brief intervention may do at least as well with this approach. Additional training for the physiotherapists in cognitive behaviour techniques might improve this approach further.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Articles

Demedicalising neck pain helps patients
BMJ 2005 330: 0. [Full Text] [PDF]

Physiotherapy for neck and back pain

Nicholas Harvey and Cyrus Cooper
BMJ 2005 330: 53-54. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Boutron, I., Moher, D., Altman, D. G., Schulz, K. F., Ravaud, P., for the CONSORT Group, (2008). Extending the CONSORT Statement to Randomized Trials of Nonpharmacologic Treatment: Explanation and Elaboration. ANN INTERN MED 148: 295-309 [Abstract] [Full text]  
• Fritz, J. M, Brennan, G. P (2007). Preliminary Examination of a Proposed Treatment-Based Classification System for Patients Receiving Physical Therapy Interventions for Neck Pain. ptjournal 87: 513-524 [Abstract] [Full text]  
• Klaber Moffett, J., Jackson, D. A., Gardiner, E. D., Torgerson, D. J., Coulton, S., Eaton, S., Mooney, M. P., Pickering, C., Green, A. J., Walker, L. G., May, S., Young, S. (2006). Randomized trial of two physiotherapy interventions for primary care neck and back pain patients: 'McKenzie' vs brief physiotherapy pain management. Rheumatology (Oxford) 45: 1514-1521 [Abstract] [Full text]  
• Underwood, M. R., Harding, G., Klaber Moffett, J., in collaboration with the UK BEAM trial team, (2006). Patient perceptions of physical therapy within a trial for back pain treatments (UK BEAM) [ISRCTN32683578]. Rheumatology (Oxford) 45: 751-756 [Abstract] [Full text]  
• Moffett, J., McLean, S. (2006). The role of physiotherapy in the management of non-specific back pain and neck pain. Rheumatology (Oxford) 45: 371-378 [Abstract] [Full text]  
• Torgerson, D., Moffett, J. K. (2005). Patient Preference and Validity of Randomized Controlled Trials. JAMA 294: 41-42 [Full text]  
• (2005). A Study of Brief Therapy for Neck Pain. JWatch General 2005: 6-6 [Full text]  
• Harvey, N., Cooper, C. (2005). Physiotherapy for neck and back pain. BMJ 330: 53-54 [Full text]  

Rapid Responses:

Read all Rapid Responses

A wider perspective

Saravana Kumar
bmj.com, 10 Jan 2005 [Full text]

Developing the Evidence: CPA Response to "Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients' preference"

Dawn L. Burnett PT, PhD
bmj.com, 11 Jan 2005 [Full text]

Too little benefit for too few patients

MARTIN CAICOYA
bmj.com, 12 Jan 2005 [Full text]

Error in Figure 2

Roland A. Ammann
bmj.com, 12 Jan 2005 [Full text]

Patient preferences and random allocation of treatment

Pythia T Nieuwkerk, et al.
bmj.com, 13 Jan 2005 [Full text]

Is there an alternative conclusion?

John A Mathews, et al.
bmj.com, 29 Jan 2005 [Full text]

What is "Usual Physiotherapy?"

Diane U. Jette
bmj.com, 4 Feb 2005 [Full text]

Interventions with similar efficacy to placebo: a useless randomised controlled trial

Francisco M. Kovacs, et al.
bmj.com, 18 Feb 2005 [Full text]