PHYSIOTHERAPIST-DIRECTED EXERCISE, ADVICE, OR BOTH FOR SUBACUTE LOW BACK PAIN. A RANDOMIZED TRIAL

Pengel LHM, Refshauge KM, Maher CG, et al. Ann Intern Med 2007;146:787–96.

Background:

Although advice (mainly by general practitioners) and exercise (mainly by physiotherapists) are recommended for the management of subacute low back pain, there is little evidence to support these treatments.

Research question/s:

How effective is physiotherapist-prescribed exercise, advice, or both for the treatment of subacute (6–12 weeks’ duration) low back pain?

Methodology:

Subjects: 259 patients with subacute low back pain (> 6 weeks and < 3 months’ duration).

Experimental procedure: All the subjects underwent initial assessment, and were then randomly assigned to one of four groups for treatment over 6 weeks: sham exercise and sham advice (CON = 68), physiotherapist-directed exercise (12 exercise sessions) and sham advice (EX = 65), physiotherapist-directed advice (ADV = 63, three sessions) and sham exercise, and physiotherapy advice and exercise (EX+ADV = 63). Pain over the past week (scale 0–10), function (Patient-Specific Functional Scale), global perceived effect (11-point scale), disability (Roland-Morris Disability Questionnaire), number of healthcare contacts, and depression (Depression Anxiety Stress Scales–21) were assessed before treatment and at 6, 12 and 52 weeks.

Main measures of outcome: Pain, function, and global perceived effect.

Main finding/s:

6 weeks: EX, ADV, and EX+ADV were more effective in decreasing pain compared with CON at 6 weeks. EX+ADV were also more effective in improving function and global effect compared with CON (p = 0.005).

12 months: EX+ADV was …