Background: Recommendations for the management of low back pain in primary ca re emphasise the importance of recognising and addressing psychosocial factors a t an early stage. We compared the effectiveness of a brief pain- management pro gramme with physiotherapy incorporating manual therapy for the reduction of disa bility at 12 months in patients consulting primary care with subacute low back p ain. Methods: For this pragmatic, multicentre, randomised clinical trial, eligib le participants consulted primary care with non- specific low back pain of less than 12 weeks’ duration. They were randomly assigned either a programme of pa in 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. Ana lysis was by intention to treat. Findings: Of 544 patients assessed for eligibil ity, 402 were recruited (mean age 40.6 years) and 329 (82% )- reached 12- mon th follow- up. Mean disability scores were 13.8 (SD 4.8) for the pain- managem ent group and 13.3 (4.9) for the manual- therapy group. The mean decreases in d isability 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 patie nt 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. Interpretation: Brief pain management techniques delivered by appropri ately trained clinicians offer an alternative to physiotherapy incorporating man ual therapy and could provide a more efficient first- line approach for managem ent of non- specific subacute low back pain in primary care.
展开▼
