Physiotherapy 'ineffective' for back pain

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Physiotherapy for back pain is no more effective than simple advice to stay active, according to a study which found that almost all treatment offered by NHS physiotherapists each year to the 1.3 million patients with back pain is useless.

Physiotherapy for back pain is no more effective than simple advice to stay active, according to a study which found that almost all treatment offered by NHS physiotherapists each year to the 1.3 million patients with back pain is useless.

Back pain is one of the most common reasons for a patient to consult a GP, but one of the hardest to treat. Doctors can prescribe painkillers and anti-inflammatories but are often unable to offer any further advice. Referral for physiotherapy is a popular option because GPs feel they are doing something positive and patients feel their problems are being taken seriously.

Researchers from the University of Warwick found this brought little benefit. They studied 286 patients who had suffered back pain for at least six weeks, half of whom were given regular physiotherapy and half simple advice. Patients in the therapy group underwent examination by a physiotherapist who nominated a treatment strategy including joint mobilisation and manipulation, stretching and heat or cold treatment.

The advice group had a single session, lasting up to an hour, with the physiotherapist who carried out a physical examination and gave general advice to remain active. After 12 months, there was no difference in disability between the two groups. But patients who had received regular sessions of physiotherapy said they felt better. The researchers concluded: "Routine physiotherapy for mild to moderate low back pain generally practised in the UK is no more effective than a session with a physiotherapist that includes advice to remain active."

They said research suggested programmes to improve cardiovascular or muscular strength were more beneficial than the routine physiotherapy commonly used in the UK.

In a commentary, Domhnall MacAuley, a Belfast GP, said: "Referral to physiotherapy is an easy option. But NHS physiotherapy adds little to an advice sheet. In a resource-limited health service we should ask serious questions about the use of resources."

A spokeswoman for the Chartered Society of Physiotherapy said: "The findings make no suggestion that physiotherapy doesn't work. The researchers have found that one-off good quality physiotherapy advice is as effective for people with moderate levels of back pain as 'routine physiotherapy', a year after the interventions. However, the patients receiving routine physiotherapy had significantly less 'bodily pain' than those receiving only advice."

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