Intended for healthcare professionals


Randomised controlled trial of physiotherapy compared with advice for low back pain

BMJ 2004; 329 doi: (Published 23 September 2004) Cite this as: BMJ 2004;329:708
  1. Helen Frost, research fellow1,
  2. Sarah E Lamb, professor of rehabilitation1,
  3. Helen A Doll, medical statistician2,
  4. Patricia Taffe Carver, trial coordinator,
  5. Sarah Stewart-Brown, professor of public health
  1. 1 Division of Health in the Community, Warwick Medical School, University of Warwick, Warwick CV4 7AL
  2. 2 Health Services Research Unit, Department of Public Health, University of Oxford
  3. 3 Nuffield Orthopaedic Centre NHS Trust, Oxford
  1. Correspondence to: H Frost
  • Accepted 19 July 2004


Objective To measure the effectiveness of routine physiotherapy compared with an assessment session and advice from a physiotherapist for patients with low back pain.

Design Pragmatic, multicentre, randomised controlled trial.

Setting Seven British NHS physiotherapy departments.

Participants 286 patients with low back pain of more than six weeks' duration.

Intervention Routine physiotherapy or advice on remaining active from a physiotherapist. Both groups received an advice book.

Main outcome measures Primary outcome was scores on the Oswestry disability index at 12 months. Secondary outcomes were scores on the Oswestry disability index (two and six months), scores on the Roland and Morris disability questionnaire and SF-36 (2, 6 and 12 months), and patient perceived benefit from treatment (2, 6, and 12 months).

Results 200 of 286 patients (70%) provided follow up information at 12 months. Patients in the therapy group reported enhanced perceptions of benefit, but there was no evidence of a long term effect of physiotherapy in either disease specific or generic outcome measures (mean difference in change in Oswestry disability index scores at 12 months −1.0%, 95% confidence interval −3.7% to 1.6%). The most common treatments were low velocity spinal joint mobilisation techniques (72%, 104 of 144 patients) and lumbar spine mobility and abdominal strengthening exercises (94%, 136 patients).

Conclusions Routine physiotherapy seemed to be no more effective than one session of assessment and advice from a physiotherapist.


  • Embedded ImageResults for patients with valid data at each assessment are on

    We thank the physiotherapists: Farida Barma, David Beard, Helen Dawes, Kirstie Haywood, Valerie McKee, Mary Pinkney, and Liz Walker; the senior physiotherapists and managers, particularly Emy Pilgrim, involved in the initial planning of the trial; the 76 physiotherapists for their cooperation and treatment of patients; and the participants. This trial was begun and implemented while HF and SEL were working in the Physiotherapy Research Unit, Nuffield Orthopaedic Centre Oxford, and we thank the staff for their help. We thank Oliver Rivero-Arias for his comments on the early drafts.

  • Contributors HF and SS-B developed the protocol, secured initial funding, and implemented the study. HF, SS-B and SEL obtained long term funding and directed the study. HD carried out the main statistical analysis. HF wrote the original draft with SS-B, SEL, and HD. PT-C helped with the final draft, entered the data, organised the trial, and carried out some categorical analysis of data. HF, SEL, and SS-B are guarantors.

  • Funding Arthritis Research Campaign.

  • Competing interests None declared.

  • Ethical approval This study was approved by the Oxford Nursing and Allied Professions research ethics committee and the West Berkshire local ethics committee.

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