Objective: To assess the effect of the Active Spinal Rehabilitation Programme (ASRP) at four years after completion and its impact upon re-referral rates to General Practitioners and Orthopaedic Consultants.

Design: Patients included in the previous twelve-month follow-up study were sent a further explanatory letter and questionnaire including functional goal, exercise, analgesia intake, GP visit, consultant referral, employment status, revised Oswestry Low Back Pain Disability Index and Visual Analogue Scale (VAS)

Subjects: The first 140 patients completing the programme between April 1997–1998 were included in this study. An overall response rate of 85% (119 out of 140) was achieved with the aid of a follow-up telephone call (to those who did not respond to the postal questionnaire)

Results: The results obtained were comparable to those at one-year follow up. There was an improved VAS in 46% of the patients at four years post ASRP compared with VAS immediately after completion. The Oswestry Score was improved (decrease in patient perceived disability) in 55% of the patients. 56% of the patients achieved their functional goal and 83% felt in control of their pain. 57% of the patients did not visit their GP in the 12 months prior to the four-year follow up and 76% did not require Consultant referral after completing ASRP.

Conclusion: This study shows that the multiple benefits of an active spinal rehabilitation programme can be maintained for a four-year period, with a significant reduction in the demands on NHS resources.