A randomized clinical trial comparing two physiotherapy interventions for chronic low back pain

Study Design. A randomized clinical trial with blinded assessment. Objectives. To investigate the clinical efficacy of 2 active interventions for patients with chronic low back pain. Summary of Background Data. Manual therapy and exercise prescription are treatments frequently prescribed for patients with chronic low back pain. The evidence for the relative benefit of these treatments is limited, and questions concerning the most appropriate type of intervention remain unanswered. Methods. Eighty patients with chronic low back pain (>3 months) were randomized to one of the following treatments, involving 8 treatments over 8 weeks; 1) one-to-one treatment involving 30 minutes of manual therapy (mobilizations to the spine) and spinal stabilization exercises, and 2) a 10 station exercise class involving aerobic exercises, spinal stabilization exercises, and manual therapy. Three physiotherapists led the hour long group with a maximum of 10 patients. Questionnaires were completed, and physical measurements were taken by a blinded observer before randomization, at the completion of treatment, and at 6 months and 12 months after the completion of treatment. The intention-to-treat principle was used in data analysis. Results. Eleven patients dropped out of the individual treatment sessions and 7 dropped out of the exercise group. There was a significant reduction ( reduced disability) in the questionnaire score in both groups, and there were significant increases in range for all the physical movements tested in both groups. The exercise group was 40% more cost effective than the individual treatments. Conclusion. Both forms of intervention were associated with significant improvement. On-going clinical research is necessary to provide guidance as to the clinical efficacy of various forms of intervention.