United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care

Abstract

Objective To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain.

Essential literature for the chiropractic profession: Results and implementation challenges from a survey of international chiropractic faculty

“…For example, chiropractic faculty recommended 13 papers on key clinical trials or observational studies on chiropractic, spinal manipulation, or manual therapy techniques. 25,29,32,34,44,60,62,64,65,72 These teachers cited numerous articles (n ¼ 9) on clinical decision making, such as classification systems, algorithms, or clinical prediction rules. 9,19,42,51,70,102,110,111,149 Recent systematic reviews, clinical guidelines, and best practices related to conservative care of musculoskeletal conditions also garnered many endorsements (n ¼ 9).…”

Alexander technique and Supervised Physiotherapy Exercises in back paiN (ASPEN): a four-group randomised feasibility trial

“…[4][5][6] Systematic reviews support strengthening, stretching and aerobic exercises; exercises tailored to the individual that can also be performed at home; 20 hours of contact time (10 group sessions); and exercise targeting the rehabilitation of deep abdominal and lumbar paraspinal muscles. 4,6,7 The National Institute for Health and Care Excellence (NICE) has reviewed the literature since the above systematic reviews and, although supervised and tailored exercises were supported by NICE as one option for patients, 8 the advice was tempered by the results from the major UK back pain exercise and manipulation (BEAM) trial, 9 which found modest effects of exercise alone or with manipulation. However, attendance at exercise sessions in the UK BEAM trial was poor and exercises in this trial did not target the rehabilitation of deep abdominal and lumbar paraspinal muscles, which are known to require specific rehabilitation, 10,11 suggesting that further trials could helpfully address both of these issues.…”

“…Patients thus had chronic or recurrent back pain [had attended their GP previously (prevalent) or currently (incident) with back pain]. These were the key entry criteria that we used in our previous trial 12 and were similar to those used in the UK BEAM trial, 9 which has the great advantage of allowing a comparison with these trials. In the previous trial 12 these criteria facilitated timely recruitment, were feasible and provided a population that had predominantly chronic pain and a control population that was relatively stable for a year despite having access to further care if needed (the control group reported on average 21 days of pain each month at the end of the year).…”

“…A group intervention, although not commonly used currently in the NHS, is supported by NICE 8 as it is more likely to be cost-effective; hence, this package could have significant implications for future NHS care. We based the optimal exercise package on those developed previously, and this was consistent with current recommendations and systematic reviews; 4,6,7,9,10,11,22,[25][26][27] it included motor relearning, strengthening, stretching and aerobic exercises; exercises tailored to the individual that can also be performed at home; 20 hours of contact time (10-12 group sessions); and exercise targeting motor control of deep abdominal and lumbar paraspinal muscles. There was time to share success and encourage other group members in group sessions and group exercises, and we paid attention to negotiating agreement to attend most sessions, as poor attendance was an important issue in the UK BEAM trial.…”

“…9 Transport to and from sessions was problematic for those without a car and so we arranged taxi collection and delivery when necessary (and so travel expenses for patients were a little more than anticipated). The time commitment for the classes, and particularly for the combined intervention, was a large burden, which suggests that, if the combined intervention is to be used, the intervention should be largely serially and flexibly organised rather than sessions being organised in parallel.…”