The efficacy of a short education program and a short physiotherapy program for treating low back pain in primary care: a cluster randomized trial.
METHODS
Cluster randomized clinical trial.


OBJECTIVE
To assess the efficacy of a short education program and short physiotherapy program for treating low back pain (LBP) in primary care.


BACKGROUND
There is sparse evidence on the effectiveness of education and physiotherapy programs that are short enough to be feasible in primary care.


METHODS
Sixty-nine primary care physicians were randomly assigned to 3 groups and recruited 348 patients consulting for LBP; 265 (79.8%) were chronic. All patients received usual care, were given a booklet and received a consistent 15 minutes group talk on health education, which focused on healthy nutrition habits in the control group, and on active management for LBP in the "education" and "education + physiotherapy" groups. Additionally, in the "education + physiotherapy" group, patients were given a second booklet and a 15-minute group talk on postural hygiene, and 4 one-hour physiotherapy sessions of exercise and stretching which they were encouraged to keep practicing at home. The main outcome measure was improvement of LBP-related disability at 6 months. Patients' assessment and data analyses were blinded.


RESULTS
During the 6-month follow-up period, improvement in the "control" group was negligible. Additional improvement in the "education" and "education + physiotherapy" groups was found for disability (2.0 and 2.2 Roland Morris Questionnaire points, respectively), LBP (1.8 and 2.10 Visual Analogue Scale points), referred pain (1.3 and 1.6 Visual Analogue Scale points), catastrophizing (1.6 and 1.8 Coping Strategies Questionnaire points), physical quality of life (2.9 and 2.9 SF-12 points), and mental quality of life (3.7 and 5.1 SF-12 points).


CONCLUSIONS
The addition of a short education program on active management to usual care in primary care leads to small but consistent improvements in disability, pain, and quality of life. The addition of a short physiotherapy program composed of education on postural hygiene and exercise intended to be continued at home, increases those improvements, although the magnitude of that increase is clinically irrelevant.
Albaladejo
Celia
C
Department of public Health, Regional Health Authority of Castilla-León, Valladolid, Spain.
Kovacs
Francisco M
FM
Royuela
Ana
A
del Pino
Rafael
R
Zamora
Javier
J
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D018579:Patient Selection; D026741:Physical Therapy Modalities; D011320:Primary Health Care; D011788:Quality of Life; D012720:Severity of Illness Index; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome