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Evaluation of physiotherapy intervention for non-specific sub-acute and chronic low back pain
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Frost, Helen (2007) Evaluation of physiotherapy intervention for non-specific sub-acute and chronic low back pain. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b2278874~S1
Abstract
This thesis investigates routine physiotherapy management of patients with subacute
and chronic non specific low back pain.
In a pragmatic multi-centre trial patients were randomised to receive a course of
physiotherapy treatment or advice following a bio-psychosocial model. Disease
specific, patient specific and generic measures were used to assess outcome.
The 286 patients recruited in the trial had, on average, minimal to moderate low
back pain disability. Patients reported enhanced perceptions of benefit in the
physiotherapy group but there was no evidence of a long term effect in any other
outcomes. There were no differences between the groups in NHS costs although
patients in the physiotherapy group incurred significantly higher out of pocket
expenses. Further analysis of the outcome data confirmed that the primary outcome
measure (Oswestry Disability Index) was the most responsive instrument because it
was able to detect deterioration as well as improvement.
As the trial demonstrated no additional benefit of physiotherapy over brief advice, it
was important to investigate the effectiveness of the latter. A systematic review
found limited evidence that brief bio-psychosocial advice was more effective in
reducing fear avoidance and improving back beliefs in patients with acute and subacute
low back pain compared with traditional medical advice. There was no direct
evidence to support the use of brief bio-psychosocial advice (2 sessions or less) for
reducing pain or disability.
This thesis describes research that has contributed to European guidelines for the
management of chronic low back pain and reviews extensively the literature that
seeks to evaluate physiotherapy practice. The clinical implication of this research is
that for patients with non specific low back pain of mild severity, brief advice is
likely to be as effective as prolonged physiotherapy intervention. The extent to
which a single session of advice is more effective than no intervention needs further
assessment.
Item Type: | Thesis (PhD) | ||||
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Subjects: | R Medicine > RC Internal medicine | ||||
Library of Congress Subject Headings (LCSH): | Backache -- Treatment, Backache -- Physical therapy | ||||
Official Date: | October 2007 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Warwick Medical School | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | Stewart-Brown, Sarah L. ; Lamb, S. E. (Sallie E.) | ||||
Sponsors: | Arthritis Research Campaign (Organization) ; University of Warwick | ||||
Extent: | xvi, 304 leaves | ||||
Language: | eng |
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