Wand, B., Bird, C., McAuley, J. H., Dore, C. J., MacDowell, M., & De Souza, L. H. (2004). Early intervention for the management of acute low back pain: A single blind randomised controlled trial of biopsychosocial education, manual therapy and exercise. Spine, 29 (21), 2350-2356.
Design: A single blind randomised controlled trial comparing two models of care for patients with simple acute low back pain (ALBP).
Objectives: To compare two research-based models of care for ALBP, and investigate the effect of the timing of physical intervention. Summary of Background Data National guidelines offer conflicting information on the delivery of physical treatment in the management of ALBP. Review of guidelines suggests two different models of care. Direct comparisons between these models are lacking in the literature. The present study aims to compare these two approaches to the management of ALBP.
Method: Among 804 referred patients, 102 subjects met the specific admission criteria and were randomly assigned to an ‘assess/advise/treat’ group or an ‘assess/advise/wait’ group. The intervention consisted of biopsychosocial education, manual therapy and exercise. Assessment of short-term outcome enables comparison to be made between intervention and advice to stay active. Assessment of long-term outcome enables comparison to be made between early and late intervention. Study outcomes of reported pain (VAS), functional disability (RMDQ), mood (MZSRDS, MSPQ, STAIS), general health (Euroqol) and quality of life (SF-36) were assessed at baseline, six weeks, three months and six months.
Results: At six weeks, the ‘assess/advise/treat’ group demonstrated greater improvements in disability, mood, general health and quality of life than patients in the ‘assess/advise/wait’ group (p0.05). However, mood, general health and quality of life remained significantly better in the ‘assess/advise/treat’ group (p<0.05).
Conclusions: At six weeks physiotherapy intervention is more effective than advice on staying active, leading to more rapid improvement in function, mood, quality of life and general health. The timing of intervention affects the progression of psychosocial features. If treatment is provided later, the same psychosocial benefits are not achieved. Therefore an 'assess/advise/treat' model of care seems to offer better outcomes than an 'assess/advise/wait' model of care.
peer-reviewed, acute low back pain, disability, manual therapy, exercise, biopsychosocial education, early intervention, psychosocial factors