Manual
Therapy Research
|
| Paper
Title |
United
Kingdom back pain exercise and manipulation (UK BEAM) randomised trial:
effectiveness of physical treatments for back pain in primary care
|
| Author(s) |
UK
BEAM Trial Team |
| Journal
Reference |
BMJ
2004;329;1377-1385 |
| Background
and Objective |
To estimate
the effect of adding exercise classes, spinal manipulation delivered in
NHS or private premises, or manipulation followed by exercise to “best
care” in general practice for patients consulting with back pain. |
| Design,
Setting, and Patients |
The
study was a pragmatic randomised trial with factorial design set across
181 general practices in Medical Research Council General Practice
Research Framework; 63 community settings around 14 centres across the
United Kingdom including 1334 patients consulting their general practices
about low back pain. |
| Interventions |
Patients
were randomised into general a general practice group, a group that received
spinal manipulation, a group that received exercise, and a group that
received spinal manipulation and exercise. All patients received
minimal guidance for self management including provided copies of "The
Back Book". Spinal manipulation was delivered by
chiropractors, osetopaths, medical doctors and physiotherapists according
to guidelines agreed upon by all individual groups. Exercise
consisted of group exercise protocols delivered at local community centres
where participants could complete up to 8 classes over 8 weeks and a
refresher at 12 weeks. |
| Outcome
Measures |
Scores on the
Roland Morris disability questionnaire at three and 12 months, adjusted
for centre and baseline scores. |
| Results |
All groups
improved over time. Exercise improved mean disability questionnaire scores
at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than “best
care.” For manipulation the additional improvement was 1.6 (0.8 to 2.3)
at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation
followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at
three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences
in outcome occurred between manipulation in NHS premises and in private
premises. No serious adverse events occurred. |
| Authors'
Conclusions |
Relative to
“best care” in general practice, manipulation followed by exercise
achieved a moderate benefit at three months and a small benefit at 12
months; spinal manipulation achieved a small to moderate benefit at three
months and a small benefit at 12 months; and exercise achieved a small
benefit at three months but not 12 months. |
| Clinical
Significance |
In
support of other current literature on the treatment of low back pain,
exercise in conjunction with manipulation demonstrated itself to be
superior to either treatment alone. Manipulation was slightly
superior to exercise alone. Of note, fear avoidance habits were
minimized by participants that partook in directed exercise, and all had
access to "The Back Book", but only 87% recalled seeing it, and
it was unclear as to how many actually read and reviewed the content of
the literature. It is clear that manipulation should be part of the
treatment of acute low back pain and that exercise and education on safe
practices should compliment that treatment to empower patients to safely
self manage their pain and minimize fear avoidance behaviors. |
| NOTE:
The clinical significance review is the opinion of Dr Ken Mueller based
upon the information available at the time of posting. Unauthorized
use of the section on clinical significance is prohibited by Canadian
Copyright. The above research abstract is based on information
posted on the BMJ website. Click
here for full text. For further information, please
refer to the original article utilizing the publication information
provided. January 3, 2005 |
