The objective of this investigation was to identify characteristics of randomized controlled trial participants which predict greater benefits from physical treatments for low back pain. We did a secondary analysis of the UK Back pain Exercise And Manipulation trial dataset to identify baseline characteristics predicting response to manipulation, exercise and manipulation followed by exercise (combined treatment). Rather than simply identifying factors associated with overall outcome, the study tested for the statistical significance of the interaction between treatment allocation, baseline characteristics and outcome to identify factors that predicted response to treatment. The authors conclude that baseline participant characteristics did not predict response to the UK BEAM treatment packages. Using recognized prognostic variables to select patients for different treatment packages, without first demonstrating that these factors affect response to treatment, may be inappropriate. In particular, this analysis suggests that the distinction between subacute and chronic low back pain may not be useful when considering treatment choices.
Rheumatology Advance Access published online on May 23, 2007