BMJ  2004;329:1402 (11 December), doi:10.1136/bmj.329.7479.1402

Letter

Physiotherapy compared with advice for low back pain

Targeting "physical factors" alone is not evidence based practice

The first 150 words of the full text of this article appear below.

EDITOR—Frost et al's conclusion that "routine physiotherapy" based on physical factors was no more effective than one session of assessment and advice from a physiotherapist in the management of low back pain is not surprising.1 But the defensive nature of the responses to this research is.2 3 This defensiveness arises partly from the perceived rivalry between health-care professions managing low back pain and the attention grabbing headlines used.

In recent years the evidence base has highlighted that low back pain is a multifaceted phenomenon incorporating physical impairment, psychological distress, and social interruption. Thus the effective biopsychosocial management of low back pain should reflect its multifaceted nature and not just focus on the "physical factors," as was done by Frost et al. Being an evidence based practitioner should entail identifying and managing patients' risk factors because risk factors are clinical predictors of outcome and efforts to manage them may reduce . . . [Full text of this article]

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Maureen Simmonds, professor and head

m.simmonds@soton.ac.uk, School of Health Professions and Rehabilitation Sciences, University of Southampton, Southampton SO17 1BJ

Anne Daykin, scientific officer, Physiotherapy Pain Association

School of Health Professions and Rehabilitation Sciences, University of Southampton, Southampton SO17 1BJ


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Relevant Article

Randomised controlled trial of physiotherapy compared with advice for low back pain
Helen Frost, Sarah E Lamb, Helen A Doll, Patricia Taffe Carver, and Sarah Stewart-Brown
BMJ 2004 329: 708. [Abstract] [Full Text] [PDF]

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