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Objective: To evaluate the health-related quality of life effects of muscle stretching, manual therapy and steroid injections in addition to 'stay active' care in acute or subacute low back pain patients.

Study design: A randomized, controlled trial during 10 weeks with four treatment groups.

Setting: Nine primary health care and one outpatient orthopaedic hospital department.

Subjects: One hundred and sixty patients with acute or subacute low back pain.

Interventions: Ten weeks of 'stay active' care only (group 1), or 'stay active' and muscle stretching (group 2), or 'stay active', muscle stretching and manual therapy (group 3), or 'stay active', muscle stretching, manual therapy and steroid injections (group 4).

Main measures: The Gothenburg Quality of Life instrument subscales Well-being score and Complaint score.

Results: In a multivariate analysis adjusted for possible outcome affecting variables other than the treatment given Well-being score was 68.4 (12.5), 72.1 (12.4), 72,3 (12.4) and 72.7 (12.5) in groups 1-4, respectively (P for trend <0.05). There were significant trends for the well-being components patience (P < 0.005), energy (P < 0.05), mood (P < 0.05) and family situation (P < 0.05). The remaining two components and Complaint score showed a non-significant trend towards improvement.

Conclusion: The effects on health-related quality of life were greater the larger the number of treatment modalities available. The 'stay active' treatment group, with the most restricted number of modalities, had the most modest health-related quality of life improvement, while group 4 with the most generous choice of treatment modalities, had the greatest improvement.

Objectives. To assess outcome of manual therapy in addition to stay-active care in sub-acute low back pain patients and to investigate the predictive power of pain drawing sketch variables for return to work.

Materials and methods. The study was designed as a randomised controlled trial with a factorial design, and included 160 patients with acute or sub-acute low back pain allocated to one of the four treatment groups during 10 weeks. Group 1 received stay-active care only, Group 2 the same treatment as in Group 1 + muscle stretching, Group 3 the same treatment as in Group 2 plus manual therapy, and Group 4 the same treatment as Group 3 plus steroid injections. Outcome included pain intensity, pain extension, functional and health related quality of life variables and return to work.

Results. Pain intensity and disability rating improved faster in Groups 3 and 4 than in Groups 1 and 2 (p<0.05 and p<0.05). Also health related quality of life was affected by the treatments given; the more treatment options the better the effect (trend across the groups p<0.05). Pain extension as described on a pain drawing sketch decreased in all groups across the study period. The pain modality ‘numbness’ was the most painful one among patients with no pain radiation. Pain radiation according to the pain drawing sketch was the strongest predictor for return to work (p=0.03, Wald χ²=4.56).

Conclusions. The manual therapy concept used in this study reduced pain intensity and disability rating better than the stay active concept. The effects on health related quality of life were greater the larger the number of treatment modalities available. Pain drawing information was significantly correlated with pain and functional variables. Pain radiation according to the pain drawing adds significant information to the prediction of return to work.

Background. There is a growing consensus on low back pain treatment. However, whether this extends to diagnostic labelling is still largely unknown. The aim of this report was to compare the diagnostic assessment of low back pain patients between general practitioners trained in manual therapy and orthopaedic surgeons. Methods. Population-based randomized controlled trial in which 160 patients with acute or sub-acute low back pain were assessed and treated by general practitioners or orthopaedic surgeons. Information on diagnoses and use of diagnostic imaging was obtained from medical records and physician questionnaires covering the ten-week treatment period. The Quebec Task Force classification and free text analysis were used to group diagnostic labels. Results: At baseline there were no significant differences in medical history, findings at physical examination and distribution of the Quebec Task Force diagnostic classification between the patient groups, indicating that they were similar. However, there were significant differences in physicians' use of diagnostic labels for local pain and their characterisation of radiating pain. General practitioners used more terms from manual medicine and reported more pseudoradicular pain than orthopaedic surgeons, who used non-specific pain labels, reported more true radicular pain and used more x-ray examinations. Differences were found at all times from first visit to ten week follow-up. Conclusions: There were significant differences in diagnostic assessment and use of diagnostic radiology between general practitioners and orthopaedic surgeons.

Background: Pain drawings are widely used as an assessment of patients' subjective pain in lowback pain patients being considered for surgery. Less work has been done on primary health carepatients. Moreover, the possible correlation between pain drawing modalities and other painassessment methods, such as pain score and functional variables needs to be described. Thus, theobjectives were to describe the course of pain drawings during treatment in primary health carefor low back pain patients.Methods: 160 primary health care outpatients with acute or sub-acute low back pain were studiedduring 10 weeks of a stay active concept versus manual therapy in addition to the stay activeconcept. The patients filled out 3 pain drawings each, at baseline and after 5 and 10 weeks oftreatment. In addition the patients also reported pain and functional variables during the 3measurement periods.Results: The proportion of areas marked, the mean number of areas marked (pain drawing score),mean number of modalities used (area score), and the proportion of patients with pain radiationall decreased during the 10-week treatment period. Most of the improvement occurred during thefirst half of the period. The seven different pain modalities in the pain drawing were correlated topain and functional variables. In case of no radiation some modalities were associated with morepain and disability than others, a finding that grew stronger over time. For patients with painradiation, the modality differences were smaller and inconsistent.Conclusion: Pain modalities are significantly correlated with pain and functional variables. Thereis a shift from painful modalities to less painful ones over time.

OBJECTIVES

To compare the effect of manual therapy in addition to the stay-active concept versus the stay-active concept only in low back pain patients.

STUDY DESIGN

A randomized, controlled trial during 10 weeks.

METHODS

One hundred sixty outpatients with acute or subacute low back pain were recruited from a geographically defined area. They were randomly allocated to a reference group treated with the stay-active concept and, in some cases, muscle stretching and an experimental group receiving manual therapy and, in some cases, steroid injections in addition to the stay-active concept. Pain and disability rating index were used as outcome measures.

RESULTS

At baseline, the experimental group had somewhat more pain, a higher disability rating index, and more herniated disks than the reference group. After 5 and 10 weeks, the experimental group had less pain and a lower disability rating index than the reference group.

CONCLUSIONS

The manual treatment concept used in this study in low back pain patients appears to reduce pain and disability rating better than the traditional stay-active concept.