Effectiveness and Cost-Effectiveness of Three Types of Physiotherapy Used to Reduce Chronic Low Back Pain Disability: A Pragmatic Randomized Trial With Economic Evaluation

Critchley, Duncan J.; Ratcliffe, Julie; Noonan, Sandra; Jones, Roger H.; Hurley, Michael V.

doi:10.1097/brs.0b013e318067dc26

Cited by 188Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyMedical Practices and Rehabilitation

Effectiveness and Cost-Effectiveness of Three Types of Physiotherapy Used to Reduce Chronic Low Back Pain Disability: A Pragmatic Randomized Trial With Economic Evaluation

Critchley, Duncan J., Ratcliffe, Julie, Noonan, Sandra, Jones, Roger H., Hurley, Michael V.·2007·Spine

DOI 10.1097/brs.0b013e318067dc26

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Abstract

STUDY DESIGN: Pragmatic, randomized, assessor blinded, clinical trial with economic analysis. OBJECTIVE: To compare the effectiveness and cost-effectiveness of three kinds of physiotherapy commonly used to reduce disability in chronic low back pain. SUMMARY OF BACKGROUND DATA: Physiotherapy reduces disability in chronic back pain, but there are several forms of physiotherapy and it is unclear which is most effective or cost effective. METHODS: A total of 212 patients referred to physiotherapy with chronic low back pain were randomized to receive usual outpatient physiotherapy, spinal stabilization classes, or physiotherapist-led pain management classes. Primary outcome was Roland Disability Questionnaire score 18 months from baseline; secondary measures were pain, health-related quality of life, and time off work. Healthcare costs associated with low back pain and quality-adjusted life years (QALYs) were also measured. RESULTS.: A total of 71 participants were assigned to usual outpatient physiotherapy, 72 to spinal stabilization, and 69 to physiotherapist-led pain management. A total of 160 (75%) provided follow-up data at 18 months, showing similar improvements with all interventions: mean (95% confidence intervals) Roland Disability Questionnaire score improved from 11.1 (9.6-12.6) to 6.9 (5.3-8.4) with usual outpatient physiotherapy, 12.8 (11.4-14.2) to 6.8 (4.9-8.6) with spinal stabilization, and 11.5 (9.8-13.1) to 6.5 (4.5-8.6) following pain management classes. Pain, quality of life, and time off work also improved within all groups with no between-group differences. Mean (SD) healthcare costs and QALY gain were pound474 (840) and 0.99 (0.27) for individual physiotherapy, pound379 (1040) and 0.90 (0.37) for spinal stabilization, and pound165 (202) and 1.00 (0.28) for pain management. CONCLUSIONS: For chronic low back pain, all three physiotherapy regimens improved disability and other relevant health outcomes, regardless of their content. Physiotherapist-led pain management classes offer a cost-effective alternative to usual outpatient physiotherapy and are associated with less healthcare use. A more widespread adoption of physiotherapist-led pain management could result in considerable cost savings for healthcare providers.

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The CSRI has been used widely in research examining the cost of chronic pain.
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Authors: Critchley, D. J., Ratcliffe, J., Noonan, S., Jones, R. H., & Hurley, M. V.
Affiliations: King's College London (GB)
University of Sheffield (GB)
St Thomas' Hospital (GB)
Corresponding author: Critchley, Duncan J.
Hurley, Michael V.
ORCID: Critchley, Duncan J.
Ratcliffe, Julie
Jones, Roger H.
Hurley, Michael V.
Venue: Spine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2007-06
Volume: 32
Issue: 14
Pages: 1474-1481
ISSN: 0362-2436 (ISSN-L)
DOI: 10.1097/brs.0b013e318067dc26
OpenAlex: W2010126736
Cited by: 188
References: 16
Citations by year: 2026: 2 · 2025: 2 · 2024: 11 · 2023: 8 · 2022: 3 · 2021: 8 · 2020: 9 · 2019: 8 · 2018: 9 · 2017: 10 · 2016: 19 · 2015: 9 · 2014: 10 · 2013: 17 · 2012: 12
FWCI: 7.53
Type: journal article
Language: en
Open access: closed
Locations: Spine (publishedVersion)
PubMed (publishedVersion)
Flinders Academic Commons (Flinders University) (submittedVersion)
Research Repository (Kingston University London) (submittedVersion)
Research Portal (King's College London) (submittedVersion)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords: chronic low back pain, physiotherapy, spinal stabilization, disability, cost-effectiveness, health care costs, quality-adjusted life years, time off work, health-related quality of life, pain, outpatient physical therapy, health economics, health technology assessment, back pain rehabilitation, spinal manipulation
MeSH terms: Adult, Analysis of Variance, Chronic Disease, Cost-Benefit Analysis, Data Collection, Disability Evaluation, Female, Humans, Male, Middle Aged, Pain Measurement, Chi-Square Distribution, Treatment Outcome, Low Back Pain, Quality-Adjusted Life Years, Physical Therapy Modalities

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Effectiveness and Cost-Effectiveness of Three Types of Physiotherapy Used to Reduce Chronic Low Back Pain Disability: A Pragmatic Randomized Trial With Economic Evaluation

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