Effectiveness and Cost-Effectiveness of Three Types of Physiotherapy Used to Reduce Chronic Low Back Pain Disability: A Pragmatic Randomized Trial With Economic Evaluation

Critchley DJ, Ratcliffe J, Noonan S, Jones RH, Hurley MV.

This study was a pragmatic, randomized, assessor blinded, clinical trial with economic analysis intended to compare the effectiveness and cost-effectiveness of three kinds of physiotherapy commonly used to reduce disability in chronic low back pain. Physiotherapy reduces disability in chronic back pain, but there are several forms of physiotherapy and it is unclear which is most effective or cost effective. A total of 71 participants were assigned to usual outpatient physiotherapy, 72 to spinal stabilization, and 69 to physiotherapist-led pain management. A total of 160 (75%) provided follow-up data at 18 months, showing similar improvements with all interventions: mean (95% confidence intervals) Roland Disability Questionnaire score improved from 11.1 (9.6–12.6) to 6.9 (5.3–8.4) with usual outpatient physiotherapy, 12.8 (11.4-14.2) to 6.8 (4.9–8.6) with spinal stabilization, and 11.5 (9.8–13.1) to 6.5 (4.5–8.6) following pain management classes. For chronic low back pain, all three physiotherapy regimens improved disability and other relevant health outcomes, regardless of their content. Physiotherapist-led pain management classes offer a cost-effective alternative to usual outpatient physiotherapy and are associated with less healthcare use. A more widespread adoption of physiotherapist-led pain management could result in considerable cost savings for healthcare providers.

Spine, 2007, 32(14), 1474-81.

Link to Abstract.