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Dates: 2000-completed 2004
Funding: Arthritis Research Campaign
Collaborators: Nuffield Orthopaedic NHS Trust and University of Oxford
Information: Oliver Rivero-Arias

Low back pain is a disability experienced by a large number of individuals of working age with a prevalence between 15% and 40% in Western countries. However, the effectiveness of physiotherapy and other interventions to alleviate pain symptoms remains unknown. This pragmatic multi-centre randomised controlled trial was designed to assess the effectiveness and cost-effectiveness of routine physiotherapy compared to back care advice given by a physiotherapist.

Data were collected on back pain related NHS and patients costs over a 12 month post randomisation period. The primary outcome measure was the Oswestry Disability Index (ODI) at 12 months, with additional ODI measures at 2 and 6 months. The EuroQol (EQ-5D) was used to calculate quality-adjusted life years (QALYs). Cost effectiveness was expressed as the incremental cost per QALY gained.

The clinical results of this trial were reported in the BMJ in 2004 and the full results of the economic evaluation were published in Spine in 2006.

The results indicated no significant differences in either NHS costs or quality of life. However, the significantly higher out-of-pocket expenses incurred by patients receiving routine physiotherapy suggests that advice given by a physiotherapist should be considered as the first-line treatment for patients with this level of back pain disability.


Rivero-Arias, O, Gray, A, Frost, H, Lamb, SE, and Stewart-Brown, S (2006). Cost-utility analysis of physiotherapy treatment compared with physiotherapy advice in low back pain. Spine 31(12):1381-7.