WM answer to low back pain - duh uh !

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http://bmj.bmjjournals.com/cgi/content/abstract/bmj.38216.868808.7Cv1

 

Randomised controlled trial of physiotherapy compared with advice for low

back pain

Helen Frost 1, Sarah E Lamb 1, Helen A Doll 2, Patricia Taffe Carver 3,

Sarah Stewart-Brown 1

1 Division of Health in the Community, Warwick Medical School, University of

Warwick, Warwick CV4 7AL

2 Health Services Research Unit, Department of Public Health, University of

Oxford

3 Nuffield Orthopaedic Centre NHS Trust, Oxford

 

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 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 (2 and 6 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).

 

Conclusion Routine physiotherapy seemed to be no more effective than one

session of assessment and advice from a physiotherapist. (Accepted 19 July

2004)

 

Sammy

 

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