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We thank Travers et al1 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 …
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