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Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients' preference

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.38286.493206.82 (Published 06 January 2005) Cite this as: BMJ 2005;330:75
  1. Jennifer A Klaber Moffett, deputy director (j.k.moffett{at}hull.ac.uk)1,
  2. David A Jackson, Hull and East Riding Community NHS Health Trust, effectiveness facilitator1,
  3. Stewart Richmond, clinical trials coordinator2,
  4. Seokyung Hahn, lecturer3,
  5. Simon Coulton, data manager, York Trials Unit3,
  6. Amanda Farrin, medical statistician, York Trials Unit3,
  7. Andrea Manca, research fellow4,
  8. David J Torgerson, director, York Trials Unit3
  1. 1Institute of Rehabilitation, University of Hull, Hull HU3 2PG
  2. 2Department of Public Health and Primary Care, University of Hull, Hull HU6 7RX
  3. 3Department of Health Sciences, University of York, York YO10 5DD
  4. 4Centre for Health Economics, University of York
  1. Correspondence to: J K Moffett
  • Accepted 18 October 2004

Abstract

Objectives Firstly, to compare the effectiveness of a brief physiotherapy intervention with “usual” physiotherapy for patients with neck pain. Secondly, to evaluate the effect of patients' preferences on outcome.

Design Non-inferiority randomised controlled trial eliciting preferences independently of randomisation.

Setting Physiotherapy departments in a community setting in Yorkshire and north Lincolnshire.

Participants 268 patients (mean age 48 years) with subacute and chronic neck pain, who were referred by their general practitioner and randomly assigned to a brief physiotherapy intervention (one to three sessions) using cognitive behaviour principles to encourage self management and return to normal function or usual physiotherapy, at the discretion of the physiotherapist concerned.

Main outcome measures The Northwick Park neck pain questionnaire (NPQ), a specific measure of functional disability resulting from neck pain. Also, the short form 36 (SF-36) questionnaire, a generic, health related, quality of life measure; and the Tampa scale for kinesophobia, a measure of fear and avoidance of movement.

Results At 12 months, patients allocated to usual physiotherapy had a small but significant improvement in NPQ scores compared with patients in the brief intervention group (mean difference 1.99, 95% confidence interval 0.45 to 3.52; P = 0.01). Although the result shows a significant inferiority of the intervention, the confidence interval shows that the effect could be in the non-inferiority range for the brief intervention (below 1.2 points of NPQ score). Patients who preferred the brief intervention and received this treatment had similar outcomes to patients receiving usual physiotherapy.

Conclusions Usual physiotherapy may be only marginally better than a brief physiotherapy intervention for neck pain. Patients with a preference for the brief intervention may do at least as well with this approach. Additional training for the physiotherapists in cognitive behaviour techniques might improve this approach further.

Footnotes

  • Contributors JKM conceived and developed the study design and protocol, and was the main grant holder and principal investigator. She took the lead in writing the paper, submitted successive drafts, and is the guarantor. SC was a member of the trial management team contributing to the development and implementation of the trial protocol with specialist contribution to the design, development, and implementation of the data management strategy and randomisation procedure. He contributed to the analysis and interpretation of results and reviewed successive drafts of this paper. AF was the statistician who carried out the preliminary statistical analysis and contributed to drafts of the paper. SH designed, carried out, and interpreted the statistical analyses of clinical outcomes. She contributed to writing up the paper, principally the methods and results. DAJ was a grant holder and helped with the development of the trial protocol and training materials used in the trial. He also assessed most of the patients included in the trial and contributed to early and later drafts of the paper. AM was assistant trial economist, responsible for designing and implementing the economic analysis plan. He estimated unit costs, interpreted economic data, and contributed to drafting the paper. Stewart Richmond was the trial coordinator from November 2000 onwards. He contributed to drafting the paper. DT contributed to drafts of the paper, advised on analysis and study design, and supervised the economic analysis. He is a grant holder for the project. Other contributors include Ian Russell, previously director of Health Sciences, University of York, who was a grant holder and provided advice with the trial design. Leslie G Walker, clinical psychologist and director of the Institute of Rehabilitation, University of Hull contributed to the training of physiotherapists for the brief physiotherapy intervention. The late Patty Collier acted as trial coordinator for eighteen months.

  • Funding Northern and Yorkshire R&D Executive and Trent Region NHS Executive.

  • Competing interests None declared.

  • Ethical approval Hull and East Riding Research Ethics Committee, Scarborough and North East Yorkshire Locally Organised Research Ethics Committee, South Humber Health Authority Local Research Ethics Committee.

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