BMJ  2005;330:674 (19 March), doi:10.1136/bmj.330.7492.674-a

Letter

United Kingdom back pain exercise and manipulation (UK BEAM) trial

Is manipulation the most cost effective addition to "best care"?

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

EDITOR—We are surprised by the conclusions of the two papers by the UK BEAM Trial Team.^{1 2} The authors compared three interventions: manipulation, exercise, and the combination of manipulation and exercise. In the recently published European guidelines for treatment of chronic low back pain (www.backpaineurope.org) the trial is rated as of high quality.³ However, the treatment effects are small, and they are not clinically significant.⁴

Surprisingly, there are no comparisons between the treatments. So far as we can tell from the information given in the papers, simple Student's t-tests do not show any significant differences between exercise and manipulation on Roland Morris or the physical component scale of the SF-36. The only significant difference is on the mental component scale of the SF-36, manipulation being significantly better than exercise at three months.

It is, therefore, difficult to follow why the authors claim that spinal manipulation is a . . . [Full text of this article]

Torill.Tveito@psych.uib.no, Department of Biological and Medical Psychology, University of Bergen, Jonas Liesvei 91, N-5009 Bergen, Norway

Department of Biological and Medical Psychology, University of Bergen, Jonas Liesvei 91, N-5009 Bergen, Norway

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