Individual active treatment combined with group exercise for acute and subacute low back pain

Study Design. Randomized controlled trial. Objective. To compare two fast-access evidence-based interventions for the treatment of simple low back pain. Subjects. People aged 18 - 65 with a new episode of simple back pain causing them to be off work or on modified work for less than 1 year. Setting. A district general hospital using a consultation/treatment room and a rehabilitation gym. Methods. One group received a back advice booklet and one session of advice and then followed the normal route of care as directed by their general practitioner. The other group received the back booklet and one session of advice and also a back program. The back program consisted of a full assessment, immediately followed by one individual treatment, and then exercise classes over 1 to 2 weeks. Outcome Measures. (1) Rate of return to work, (2) pain scores and health status, and (3) cost effectiveness of interventions versus the financial cost to the individual or employer. Results. On average, those receiving the individual treatment and group exercise took 7 days less off work. This represented a 35% reduction in the amount of time taken off work since study entry. The estimated cost saving of providing the extra service of a simple back program ranged between 250 (US$367, euro300) and 578 (US$850, euro694) for each patient. Conclusion. The results indicate that the costs of this active back program are more than reimbursed as a consequence of earlier return to work.