BMJ  2005;330:673-674 (19 March), doi:10.1136/bmj.330.7492.673-c

Letter

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

Touch may have had non-specific effect, among other things

EDITOR—I have three brief comments on the United Kingdom back pain exercise and manipulation (UK BEAM) trial.¹

Firstly, the data are compatible with a non-specific effect caused by touch: exercise has a significantly positive effect on back pain which can be enhanced by touch. If this "devil's advocate" view is correct, the effects have little to do with spinal manipulation itself.

Secondly, which of the three professional groups (chiropractors, osteopaths, physiotherapists) generated the largest effect size is relevant. This might significantly influence the referral pattern. A post-hoc analysis might answer this question.

Lastly, the study monitored only serious adverse effects. Data show that minor adverse effects occur in about 50% of patients after spinal manipulation.² Such adverse events might then also influence general practitioners' referrals.

Complementary Medicine, Peninsula Medical School, Exeter EX2 4NT Edzard.Ernst{at}pms.ac.uk

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Competing interests: None declared.

References

1. UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ 2004;329: 1377-81. (11 December.)[Abstract/Free Full Text]
2. Stevinson C, Ernst E. Risks associated with spinal manipulation. Am J Med 2002;112: 566-70.[Medline]

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

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