Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice
Recommendations for the management of low back pain in primary care emphasise the importance of recognising and addressing psychosocial factors at an early stage. We compared the effectiveness of a brief pain-management programme with physiotherapy incorporating manual therapy for the reduction of d...
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| Veröffentlicht in: | The Lancet (British edition) 2005-06, Vol.365 (9476), p.2024-2030 |
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| container_title | The Lancet (British edition) |
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| creator | Hay, EM Mullis, R Lewis, M Vohora, K Main, CJ Watson, P Dziedzic, KS Sim, J Lowe, C Minns Croft, PR |
| description | Recommendations for the management of low back pain in primary care emphasise the importance of recognising and addressing psychosocial factors at an early stage. We compared the effectiveness of a brief pain-management programme with physiotherapy incorporating manual therapy for the reduction of disability at 12 months in patients consulting primary care with subacute low back pain.
For this pragmatic, multicentre, randomised clinical trial, eligible participants consulted primary care with non-specific low back pain of less than 12 weeks' duration. They were randomly assigned either a programme of pain management (n=201) or manual therapy (n=201). The primary outcome was change in the score on the Roland and Morris disability questionnaire at 12 months. Analysis was by intention to treat.
Of 544 patients assessed for eligibility, 402 were recruited (mean age 40·6 years) and 329 (82%) reached 12-month follow-up. Mean disability scores were 13·8 (SD 4·8) for the pain-management group and 13·3 (4·9) for the manual-therapy group. The mean decreases in disability scores were 8·8 (6·4) and 8·8 (6·1) at 12 months (difference 0 [95% CI −1·3 to 1·4], p=0·99), and median numbers of physiotherapy visits per patient were three (IQR one to five) and four (two to five), respectively (p=0·001). One adverse reaction (an exacerbation of pain after the initial assessment) was recorded.
Brief pain management techniques delivered by appropriately trained clinicians offer an alternative to physiotherapy incorporating manual therapy and could provide a more efficient first-line approach for management of non-specific subacute low back pain in primary care. |
| doi_str_mv | 10.1016/S0140-6736(05)66696-2 |
| format | Article |
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For this pragmatic, multicentre, randomised clinical trial, eligible participants consulted primary care with non-specific low back pain of less than 12 weeks' duration. They were randomly assigned either a programme of pain management (n=201) or manual therapy (n=201). The primary outcome was change in the score on the Roland and Morris disability questionnaire at 12 months. Analysis was by intention to treat.
Of 544 patients assessed for eligibility, 402 were recruited (mean age 40·6 years) and 329 (82%) reached 12-month follow-up. Mean disability scores were 13·8 (SD 4·8) for the pain-management group and 13·3 (4·9) for the manual-therapy group. The mean decreases in disability scores were 8·8 (6·4) and 8·8 (6·1) at 12 months (difference 0 [95% CI −1·3 to 1·4], p=0·99), and median numbers of physiotherapy visits per patient were three (IQR one to five) and four (two to five), respectively (p=0·001). One adverse reaction (an exacerbation of pain after the initial assessment) was recorded.
Brief pain management techniques delivered by appropriately trained clinicians offer an alternative to physiotherapy incorporating manual therapy and could provide a more efficient first-line approach for management of non-specific subacute low back pain in primary care.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(05)66696-2</identifier><identifier>PMID: 15950716</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Acute Disease ; Adolescent ; Adult ; Attitude to Health ; Back ; Biological and medical sciences ; Clinical trials ; Cognitive Therapy ; Comparative analysis ; Diseases of the osteoarticular system ; Diseases of the spine ; Female ; General aspects ; Humans ; Low back pain ; Low Back Pain - psychology ; Low Back Pain - therapy ; Male ; Medical sciences ; Middle Aged ; Pain ; Pain management ; Physical Therapy Modalities ; Primary care ; Primary Health Care ; Quality of Life ; Spine</subject><ispartof>The Lancet (British edition), 2005-06, Vol.365 (9476), p.2024-2030</ispartof><rights>2005 Elsevier Ltd</rights><rights>2005 INIST-CNRS</rights><rights>Copyright Lancet Ltd. Jun 11-Jun 17, 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c420t-a77a6b8ae6d7c9dac486b0b6618fb81fa6c96914c1116bd3d0b6aac2b0ff9e2b3</citedby><cites>FETCH-LOGICAL-c420t-a77a6b8ae6d7c9dac486b0b6618fb81fa6c96914c1116bd3d0b6aac2b0ff9e2b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0140673605666962$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16848113$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15950716$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hay, EM</creatorcontrib><creatorcontrib>Mullis, R</creatorcontrib><creatorcontrib>Lewis, M</creatorcontrib><creatorcontrib>Vohora, K</creatorcontrib><creatorcontrib>Main, CJ</creatorcontrib><creatorcontrib>Watson, P</creatorcontrib><creatorcontrib>Dziedzic, KS</creatorcontrib><creatorcontrib>Sim, J</creatorcontrib><creatorcontrib>Lowe, C Minns</creatorcontrib><creatorcontrib>Croft, PR</creatorcontrib><title>Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Recommendations for the management of low back pain in primary care emphasise the importance of recognising and addressing psychosocial factors at an early stage. We compared the effectiveness of a brief pain-management programme with physiotherapy incorporating manual therapy for the reduction of disability at 12 months in patients consulting primary care with subacute low back pain.
For this pragmatic, multicentre, randomised clinical trial, eligible participants consulted primary care with non-specific low back pain of less than 12 weeks' duration. They were randomly assigned either a programme of pain management (n=201) or manual therapy (n=201). The primary outcome was change in the score on the Roland and Morris disability questionnaire at 12 months. Analysis was by intention to treat.
Of 544 patients assessed for eligibility, 402 were recruited (mean age 40·6 years) and 329 (82%) reached 12-month follow-up. Mean disability scores were 13·8 (SD 4·8) for the pain-management group and 13·3 (4·9) for the manual-therapy group. The mean decreases in disability scores were 8·8 (6·4) and 8·8 (6·1) at 12 months (difference 0 [95% CI −1·3 to 1·4], p=0·99), and median numbers of physiotherapy visits per patient were three (IQR one to five) and four (two to five), respectively (p=0·001). One adverse reaction (an exacerbation of pain after the initial assessment) was recorded.
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edition)</jtitle><addtitle>Lancet</addtitle><date>2005-06-11</date><risdate>2005</risdate><volume>365</volume><issue>9476</issue><spage>2024</spage><epage>2030</epage><pages>2024-2030</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Recommendations for the management of low back pain in primary care emphasise the importance of recognising and addressing psychosocial factors at an early stage. We compared the effectiveness of a brief pain-management programme with physiotherapy incorporating manual therapy for the reduction of disability at 12 months in patients consulting primary care with subacute low back pain.
For this pragmatic, multicentre, randomised clinical trial, eligible participants consulted primary care with non-specific low back pain of less than 12 weeks' duration. They were randomly assigned either a programme of pain management (n=201) or manual therapy (n=201). The primary outcome was change in the score on the Roland and Morris disability questionnaire at 12 months. Analysis was by intention to treat.
Of 544 patients assessed for eligibility, 402 were recruited (mean age 40·6 years) and 329 (82%) reached 12-month follow-up. Mean disability scores were 13·8 (SD 4·8) for the pain-management group and 13·3 (4·9) for the manual-therapy group. The mean decreases in disability scores were 8·8 (6·4) and 8·8 (6·1) at 12 months (difference 0 [95% CI −1·3 to 1·4], p=0·99), and median numbers of physiotherapy visits per patient were three (IQR one to five) and four (two to five), respectively (p=0·001). One adverse reaction (an exacerbation of pain after the initial assessment) was recorded.
Brief pain management techniques delivered by appropriately trained clinicians offer an alternative to physiotherapy incorporating manual therapy and could provide a more efficient first-line approach for management of non-specific subacute low back pain in primary care.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>15950716</pmid><doi>10.1016/S0140-6736(05)66696-2</doi><tpages>7</tpages></addata></record> |
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| subjects | Acute Disease Adolescent Adult Attitude to Health Back Biological and medical sciences Clinical trials Cognitive Therapy Comparative analysis Diseases of the osteoarticular system Diseases of the spine Female General aspects Humans Low back pain Low Back Pain - psychology Low Back Pain - therapy Male Medical sciences Middle Aged Pain Pain management Physical Therapy Modalities Primary care Primary Health Care Quality of Life Spine |
| title | Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice |
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