Article Text

Download PDFPDF
STOPS trial versus Costa et al: a more accurate analysis
  1. Jon J Ford,
  2. Andrew John Hahne,
  3. Luke D Surkitt,
  4. Alexander Y P Chan,
  5. Matthew C Richards,
  6. Sarah L Slater,
  7. Tania Pizzari,
  8. Megan Davidson,
  9. Nicholas F Taylor
  1. College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
  1. Correspondence to Dr Jon J Ford, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3085, Australia;{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

We thank Travers et al 1 for highlighting the results of the Specific Treatment of Problems of the Spine (STOPS) trial.2 However, a number of their assertions are factually wrong, and we strongly disagree with their interpretation of our results.

Travers et al argue that the recovery trajectory of the STOPS comparison group (guideline-based advice) was worse than for participant data from a meta-analysis of cohort studies by Costa et al.3 They propose the reason for this was our advice group receiving a pathoanatomical explanation as a component of the advice intervention, which may have had a negative effect. Travers et al conclude that the lower than expected recovery trajectory for the STOPS advice group renders our statistically and likely clinically important results favouring the STOPS primary intervention (individualised physiotherapy) over advice as potentially invalid.

Comparing apples with apples

Practitioners4 and researchers5 understand that the validity and utility of research for clinical practice are influenced by the complexity of low back disorders (LBD).6 It is therefore essential that interpretation and comparison of research data are conducted using the principle of ‘apples for apples’. Travers et al suggest that the participants in the Costa et al meta-analysis were ‘broadly comparable’ with those in the STOPS trial. A closer analysis reveals that this is not the case.

Travers et al compare the Costa et al recovery trajectories for ‘acute/subacute’ LBD with the STOPS participants. However, this comparison is based on the authors’ erroneous assertion that the Costa et al’s acute group had a symptom duration of 0–12 …

View Full Text


  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles