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Clinical Trial
. 2004 Dec 11;329(7479):1377.
doi: 10.1136/bmj.38282.669225.AE. Epub 2004 Nov 19.

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care

UK BEAM Trial Team
Clinical Trial

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care

UK BEAM Trial Team. BMJ. .

Abstract

Objective: To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. [See figure].

Design: Pragmatic randomised trial with factorial design.

Setting: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom.

Participants: 1334 patients consulting their general practices about low back pain.

Main outcome measures: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores.

Results: All groups improved over time. Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than "best care." For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred.

Conclusions: Relative to "best care" in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months.

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Figures

Fig 1
Fig 1
Progress of the UK BEAM trial
Fig 2
Fig 2
Mean Roland disability questionnaire scores (with 95% confidence intervals) over 12 months by group: “best care” in general practice, best care plus exercise alone, best care plus manipulation alone, and best care plus manipulation and exercise
See this image and copyright information in PMC

Comment in

References

    1. Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain 2000;84: 95-103. - PubMed
    1. Waddell G, Feder G, McIntosh G, Lewis M, Hutchinson A. Low back pain evidence review. London: Royal College of General Practitioners, 1999.
    1. Van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain: a systematic review of randomized controlled trials of the most common interventions. Spine 1997;22: 2128-56. - PubMed
    1. Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain: a meta-analysis of effectiveness relative to other therapies. Ann Intern Med 2003;138: 871-81. - PubMed
    1. Van Tulder M, Malmivaara A, Esmail R, Koes B. Exercise therapy for low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2000;25: 2784-96. - PubMed

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