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

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 the burden of low back pain for those who consult physiotherapists.

Because of the recurrent nature of low back pain, talk of a "cure" is unrealistic. Thus the Physiotherapy Pain Association emphasises that patients should be taught skills to self manage their low back problem so that in the long term they are less likely to experience pain related disability and depression, thus improving their quality of life. Receiving passive treatments focusing on physical factors, which show only slight short term benefits, is not in the personal or economic interest of patients with low back pain.

As is highlighted by the responses to the study by Frost et al,³ beliefs about treatment preferences for low back pain vary across professions and can be traced to beliefs about the cause of the problem.

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

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

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Competing interests: None declared.

References

1. Frost H, Lamb SE, Doll HA, Taffe Carver P, Stewart-Brown S. Randomised controlled trial of physiotherapy compared with advice for low back pain. BMJ 2004;329: 708. (25 September.)[Abstract/Free Full Text]
2. Electronic responses. Back pain and physiotherapy. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/329/7468/694 (accessed 2 Dec 2004).
3. Electronic responses. Randomised controlled trial of physiotherapy compared with advice for low back pain. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/329/7468/708 (accessed 2 Dec 2004).

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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]