Physical therapy adds little to back pain treatment

Journal of Family Practice, Jan, 2005 by H. Frost, S.E. Lamb, H.A. Doll, P.T. Carver, S. Stewart-Brown

* CLINICAL QUESTION

Do patients with back pain who undergo physical therapy benefit more than those simply given advice to remain active?

* BOTTOM LINE

Physical therapy sessions do not offer any additional benefit over simple advice to remain active in patients referred for physical therapy. Patients will initially perceive a benefit while being treated, but this benefit disappears by 1 year. (LOE=2b)

* STUDY DESIGN

Randomized controlled trial (single-blinded)

* ALLOCATION

Concealed

* SETTING

Outpatient (specialty)

* SYNOPSIS

The authors of this study started with 286 patients with low back pain in the United Kingdom who were referred by their general practitioner or specialist for physical therapy. The patients were invited to participate in the study and were randomized (allocation assignment was concealed) to receive either an advice booklet from a physical therapist encouraging them to remain active, or the book plus 6 treatment sessions of physical therapy using joint mobilization and manipulation, soft tissue techniques, and strengthening exercises. Analysis was by intention to treat, although follow-up after 1 year was only 70%.

The main outcome was the change in the Oswestry disability index, a scale completed by patients that has a range from 0% (no disability) to 100% (totally disabled). There was no difference in disability 1 year after treatment assignment. Quality-of-life scores were not different at 1 year as measured by the 36-item Short-Form Health Status Survey.

Approximately 10% of patients randomized to receive advice only received physical therapy. Patients reported significantly more benefit from treatment at both 2 and 6 months, but it's likely--given that patients were aware of their treatment--that this finding reflects a placebo effect. Other research has also not shown a benefit of physical therapy for low back pain (Spine 2003; 13:1363-1372).

Frost H, Lamb SE, Doll HA, Carver PT, Stewart-Brown S. Randomised controlled trial of physiotherapy compared with advice for low back pain. BMJ 2004; 329:7087-7011.