Abstract
Background: There is some evidence for the effectiveness of exercise therapy and clearer evidence for encouraging physical activity. The Back to Fitness programme was developed with this in mind. It is a simple and inexpensive treatment aimed at increasing normal use of the spine.
Objective: To compare the effects of a group exercise programme with individual physiotherapy for low back pain patients.
Method: Back Pain patients (n=237) referred to physiotherapy departments in a materially deprived part of the North East of England were randomised either to individual physiotherapy as usual or to the Back to Fitness programme. The primary outcome measure was the Roland Disability Questionnaire (RDQ). Secondary measures were the SF12, EQ5D and Pain Self-Efficacy questionnaire. Health care diaries were collected in order to compare the health care costs for the two treatment groups. Patients were followed up 3 months and 12 months after randomisation. Analysis was by intention to treat.
Results: In line with recent studies there were no statistically significant differences between the treatment groups on any outcome measure over time. An economic analysis highlighted the cost savings of the Back to Fitness programme. However, only small improvements in disability (RDQ) scores were observed in either treatment group. This contrasts with recent studies on the effects of individual physiotherapy and exercise therapy, and with previous reports on the effects of the Back to Fitness programme. One explanation may be socio-demographic related. An exploration of the deprivation sub-groups based on the Townsend Index of Material Deprivation suggested that poorer patients may have poorer outcomes.
Conclusions: There were no significant differences at outcome between treatment groups. The exercise programme tended to be slightly beneficial but neither therapy significantly reduced disability. Further research could explore the possible impact of material deprivation on outcome.
The abstracts were prepared by Editorial Secretary, Dr Charles Pither. Correspondence should be addressed to SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN
