1334 patients who participated in the 2004 UK Beam Trial (pdf). This is quite a number! For quick summary, it is a randomized trial of patients with low back pain who were divided between a “back to fitness” exercise program, spinal manipulation, and exercise + spinal manipulation. Multiple outcomes were measured at 1, 3 and 12 months via Roland-Morris disability questionnaire, modified Von Korff scale, back belief questionnaire, fear avoidance belief questionnaire, and SF-36 and EuroQol (refer back to paper for more details).
Here is a summary of findings:
As expected, all groups showed improvement in primary and secondary outcomes, but biggest shocker is that no additional benefit of exercise group at 12 months compared to best care advice (2nd statement above). Also, manipulation alone is same at 12 months as manipulation + exercise. Best care defined as continuing normal activities and avoiding rest.
This may open up more questions than answers but is interesting from a physical therapist’s perspective. Does this mean patients will have lower disability at 3 and 12 months with manipulation? Yes. Does this mean we need manipulation and exercise for decreased disability at 3 and 12 months? Yes. Does this mean just exercise will reduce disability at 12 months? No.
I normally state something to the extent of, “you need to keep performing these exercises for long-term control”. Is this statement wrong?
What are your thoughts?