Evidence based practice can improve outcome

EDITOR —Croft et al describe 12 month outcome in low back pain.1 Their paper documents the disease course, but it is surprising that they do not describe patient management. The Royal College of General Practitioners has published evidence based guidelines for the management of acute back pain. 2 3 These guidelines recommend active management followed by manipulative treatment at 4-6 weeks if active management fails. An evidence based book for patients with back pain (The Back Book) was launched with the guidelines.4

We believe that evidence based management of acute back pain will improve outcome. While undertaking a prospective randomised controlled trial of manipulative treatment that aimed to compare the outcome of osteopathy and of physiotherapy we inadvertently showed the effectiveness of the college's guidelines. Two general practices in Kingston-upon-Hull participated in this study, with a total practice population of 15 000. Both practices are in deprived areas.

All patients presenting with acute non-specific back pain (defined as their first episode of back pain or an episode more than three months after a previous episode) were managed according to the college's guidelines; this ensured that patients in each arm of the trial were similar. Patients were advised on active management, minimal rest, early commencement of exercise, and rapid return to normal activity and work. All patients were given copies of The Back Book. They were advised to return if their symptoms deteriorated or if there was no improvement after three weeks. Patients returning to their general …