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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
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 Client Services Receipt Inventory (CSRI)65 has been used widely in research examining the cost of chronic pain18 66 67”
From Investigating the effectiveness of an online acceptance and commitment therapy (ACT) intervention versus a waiting list control condition on pain interference and quality of life in adults with chronic pain and multimorbidity: Protocol for a randomised controlled trial (2019) · cites this paper as [66]
Citations
Cites
EuroQol: the current state of play
Brooks, R. (1996) · Health Policy · doi:10.1016/0168-8510(96)00822-6 · Cited by 5,815
Analysis of serial measurements in medical research.
Matthews, J. N. S., Altman, D. G., Campbell, M. J., & Royston, P. J. (1990) · BMJ · doi:10.1136/bmj.300.6719.230 · Cited by 3,137
The Roland–Morris Disability Questionnaire and the Oswestry Disability Questionnaire
Roland, M. O., & Fairbank, J. C. T. (2000) · Spine · doi:10.1097/00007632-200012150-00006 · Cited by 1,913
The economic burden of back pain in the UK
Maniadakis, N., & Gray, A. (2000) · Pain · doi:10.1016/s0304-3959(99)00187-6 · Cited by 1,510
O’Sullivan, P., Phyty, G. D. M., Twomey, L. T., & Allison, G. T. (1997) · Spine · doi:10.1097/00007632-199712150-00020 · Cited by 1,105
Acute low back pain: systematic review of its prognosis
Pengel, L. H. M., Herbert, R., Maher, C. G., & Refshauge, K. M. (2003) · BMJ · doi:10.1136/bmj.327.7410.323 · Cited by 874
Hayden, J. A., van Tulder, M. W., & TOMLINSON, G. A. (2005) · Annals of Internal Medicine · doi:10.7326/0003-4819-142-9-200505030-00014 · Cited by 852
Long-Term Effects of Specific Stabilizing Exercises for First-Episode Low Back Pain
Hides, J. A., Jull, G. A., & Richardson, C. A. (2001) · Spine · doi:10.1097/00007632-200106010-00004 · Cited by 842
How should cost data in pragmatic randomised trials be analysed?
Thompson, S. G. (2000) · BMJ · doi:10.1136/bmj.320.7243.1197 · Cited by 772
UK BEAM Trial Team (2004) · BMJ · doi:10.1136/bmj.38282.669225.ae · Cited by 515
Flagged first, then by citations
Research works printed but not linked: 2
- Hay, 365, Lancet, 2024-, 30
- Mayer, 1987, JAMA, 258, 1763, 10.1001/jama.1987.03400130077037 · DOI
Cited by
Sorted by citations
Items 101–187 of 187
Randomized cohort trial was shown to be feasible for evaluating treatments in low back pain
Dascanio, V. C., Birks, Y. F., Clark, L., Fairhurst, C. M., MacPherson, H., & Torgerson, D. J. (2014) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2014.04.004 · Cited by 8
Manualmedizinische Syndrome bei unteren Rückenschmerzen: Teil I
Buchmann, J. A., Arens, U., Harke, G., Smolenski, U. C., & Kayser, R. (2012) · Manuelle Medizin · doi:10.1007/s00337-012-0965-9 · Cited by 8
Miki, T., Kondo, Y., Kurakata, H., Takebayashi, T., & Samukawa, M. (2023) · PM&R · doi:10.1002/pmrj.13002 · Cited by 10
Telerehabilitation for musculoskeletal disorders during the COVID-19 pandemic
Chief Physiotherapist, Y., Sheetal, M., Preeti, M., Rekha, K., Divya, S., Consultant Physiotherapist, Y., Ashutosh, M., Co-Founder, Y., Raje, D., & Statistician, M. B. (2021) · International Journal of Physiotherapy and Research · doi:10.16965/ijpr.2021.106 · Cited by 7
Schmidt, S., Wölfle, N., Schultz, C., Sielmann, D., Huber, R., & Walach, H. (2021) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-021-04236-2 · Cited by 13
Robinson, R. L., & Vetter, T. R. (2008) · Springer eBooks · doi:10.1007/978-0-387-78323-9_10 · Cited by 7
Cuesta‐Vargas, A. (2015) · Ultrasound in Medicine & Biology · doi:10.1016/j.ultrasmedbio.2015.02.015 · Cited by 7
Daulat, A. (2016) · International Musculoskeletal Medicine · doi:10.1080/17536146.2016.1261234 · Cited by 7
Fritz, J. M. (2009) · Physical Therapy · doi:10.2522/ptj.20090218.ic · Cited by 7
van Erp, R. M. A., Huijnen, I. P. J., Köke, A. J. A., Verbunt, J., & Smeets, R. (2020) · European Journal of Physiotherapy · doi:10.1080/21679169.2020.1840627 · Cited by 7
Smith‐Turchyn, J., Richardson, J. A., Sinclair, S., Xu, Y., Choo, S., Gravesande, J., Lai, A., Letts, E., Masrur, M., Morgan, A. R., et al. (2023) · Physiotherapy Canada · doi:10.3138/ptc-2022-0016 · Cited by 6
Grøn, S., Johansson, M. S., Schiphof, D., Koes, B. W., & Kongsted, A. (2024) · Public Health · doi:10.1016/j.puhe.2024.10.021 · Cited by 6
Manualmedizinische Syndrome bei unteren Rückenschmerzen: Teil II
Buchmann, J. A., Arens, U., Harke, G., Smolenski, U. C., & Kayser, R. (2012) · Manuelle Medizin · doi:10.1007/s00337-012-0966-8 · Cited by 6
Veillon, J., Preuilh, A., & Wormser, J. (2024) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2024.03.057 · Cited by 6
Çetin, H., Bilgin, S., & Köse, N. (2017) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.3233/bmr-170814 · Cited by 6
Kikuchi, S., Oe, Y., Sasaki, Y., Ishii, H., Ito, Y., Horikoshi, M., Sozu, T., Seno, H., & Furukawa, T. A. (2020) · BMC Gastroenterology · doi:10.1186/s12876-020-1157-z · Cited by 6
Eficacia de un programa de escuela de espalda hospitalario
García-Manzanares, M. D., González, M. R. M., Sunyer, M., Medina, N., Tornero, D. H., & Limón, R. (2009) · Rehabilitación · doi:10.1016/s0048-7120(09)72529-0 · Cited by 6
Stevens, J., & Barlow, S. (2014) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s58656 · Cited by 5
Image-Guided Injections of the Hip
Singh, J. (2014) · Journal of Novel Physiotherapy and Physical Rehabilitation · doi:10.17352/2455-5487.000008 · Cited by 5
Watchful Waiting and Brief Education
Pradhan, B. B., Brox, J. I., & Indahl, A. (2011) · Elsevier eBooks · doi:10.1016/b978-0-323-07293-9.00006-4 · Cited by 5
Schembri, E. (2018) · SN Comprehensive Clinical Medicine · doi:10.1007/s42399-018-0022-7 · Cited by 5
Dupuis, F., Guertin, J. R., Gagnon, R., LaRue, S., Fredette, A., Hébert, L. J., Desmeules, F., Perreault, K., & Roy, J. (2025) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2025.12888 · Cited by 4
Imamura, M., Furlan, A. D., Dryden, T., & Irvin, E. (2011) · Elsevier eBooks · doi:10.1016/b978-0-323-07293-9.00016-7 · Cited by 4
Kühn, L., Lindert, L., Kuper, P., Prill, R., & Choi, K. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09166-4 · Cited by 5
Analysis of scientific truth status in controlled rehabilitation trials
Kerry, R., Madouasse, A., Arthur, A. J., & Mumford, S. D. (2012) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2012.01855.x · Cited by 4
Chamberlain, A., Munro, W., & Rickard, A. (2013) · Elsevier eBooks · doi:10.1016/b978-0-7020-4344-4.00014-6 · Cited by 4
Treating low back pain – Bridging the gap between manual therapy and exercise
Michaeli, A. (2020) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2020.06.015 · Cited by 4
Slattery, B. W., O’Connor, L. L., Haugh, S., Barrett, K., Francis, K., Dwyer, C. P., O’Higgins, S., Caes, L., Egan, J., & McGuire, B. E. (2019) · BMJ Open · doi:10.1136/bmjopen-2016-012671 · Cited by 3
Fischer, S., Böhmer, C. H., Nasrin, S., Sachse, C., & Cherif, C. (2024) · Sensors · doi:10.3390/s24237500 · Cited by 3
Physiotherapy Treatment on Chronic Non Specific Low Back Pain
Cuesta‐Vargas, A., Gonzlez-Snchez, M., Manzanares, M. T. L., & Galn-Mercant, A. (2012) · InTech eBooks · doi:10.5772/34756 · Cited by 3
Spinal Manipulation and Mobilization
Brønfort, G., Haas, M., Evans, R., Kawchuk, G. N., & Dagenais, S. (2011) · Elsevier eBooks · doi:10.1016/b978-0-323-07293-9.00017-9 · Cited by 3
Hodges, P. W., Ferreira, P. H., & Ferreira, M. L. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-31072-7.00014-2 · Cited by 3
Management of chronic low back pain in 2007–2008
Raspe, H. H. (2008) · Current Opinion in Internal Medicine · doi:10.1097/mci.0b013e32830c6dbd · Cited by 3
Rehabilitative Treatment for Chronic Pain
Robinson, J. P., Leo, R. J., Wallach, J., McGough, E. L., & Schatman, M. E. (2010) · doi:10.1002/9781444314380.ch30 · Cited by 3
Methodological Issues in Work Disability Prevention Research
Hogg‐Johnson, S., & MacEachen, E. (2013) · Springer eBooks · doi:10.1007/978-1-4614-6214-9_9 · Cited by 2
Barker, K. L. (2014) · Journal of Novel Physiotherapy and Physical Rehabilitation · doi:10.17352/2455-5487.000007 · Cited by 2
Gesundheitsökonomische Aspekte von Rückenschmerzen
Damm, O., Bowles, D., & Greiner, W. (2016) · Springer eBooks · doi:10.1007/978-3-642-29775-5_56 · Cited by 2
Berberoğlu, U., & Ülger, Ö. (2023) · Journal of Sport Rehabilitation · doi:10.1123/jsr.2022-0158 · Cited by 2
Métodos terapêuticos alternativos para o manejo da incapacidade da dor lombar crônica
Nascimento, J. M., Stefane, T., Napoleão, A. A., & Hortense, P. (2015) · Reme Revista Mineira de Enfermagem · doi:10.5935/1415-2762.20150016 · Cited by 2
The competence of physiotherapists to deliver a cognitive behavioural approach for low back pain
Hansen, Z. (2026) · Warwick Research Archive Portal (University of Warwick) · doi:10.82444/warw.33646315 · Cited by 2
Wood, L., Dean, S. G., Booth, V., Hayden, J. A., & Foster, N. E. (2024) · Musculoskeletal Care · doi:10.1002/msc.1907 · Cited by 1
Cost-effectiveness of spinal manipulation, exercise, and self-management for spinal pain
Leininger, B. D., Kuntz, K. M., Hodges, J. S., Evans, R., Enns, E. A., Johnson, P. J., & Brønfort, G. (2025) · Chiropractic & Manual Therapies · doi:10.1186/s12998-025-00599-8 · Cited by 1
Lamb, S. E., Hansen, Z., Lall, R., Castelnuova, E., Withers, E. J., Nichols, V. P., & Potter, R. C. (2010) · Osteopathische Medizin · doi:10.1016/j.ostmed.2010.04.010 · Cited by 1
Daulat, A. (2013) · International Musculoskeletal Medicine · doi:10.1179/1753615413y.0000000022 · Cited by 1
Varghese, S. (2012) · Cited by 1
Effectiveness of exercise therapy for chronic non-specific low back pain
van Middelkoop, M., Rubinstein, S. M., Verhagen, A. P., Ostelo, R., Koes, B. W., & van Tulder, M. W. (2013) · Elsevier eBooks · doi:10.1016/b978-0-7020-4356-7.00015-x · Cited by 1
Dagenais, S., & Mayer, J. M. (2011) · Elsevier eBooks · doi:10.1016/b978-0-323-07293-9.00008-8 · Cited by 1
Newton, C., Singh, G., Nolan, D., Booth, V., Diver, C. J., O’Neill, S., O’Sullivan, K., O’Sullivan, P., & Logan, P. (2021) · Physiotherapy Practice and Research · doi:10.3233/ppr-200488 · Cited by 1
Low Back Pain of Muscular Origin
Gerwin, R. D. (2010) · Springer eBooks · doi:10.1007/978-3-642-05468-6_6 · Cited by 1
Effects, Efficacy, Efficiency and Effectiveness…in Physical Therapy- How Far Are We? -
Kumar, S. P. (2011) · Cited by 1
Okyay, L. (2010) · Unitec Research Bank (Unitec Institute of Technology) · Cited by 1
Magalhães, M. O. (2016) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/t.5.2016.tde-08082016-141938 · Cited by 1
Effectiveness of a Manual Therapy Approach in Treatment of Patients with Lumbar Spinal Stenosis
Ramadan, H. A. (2019) · NSUWorks (Nova Southeastern University) · Cited by 1
Keine Kostenwirksamkeit eines Klassifikationssystems für subakute und chronische Kreuzschmerzen
Ammer, K. (2012) · Manuelle Medizin · doi:10.1007/s00337-012-0981-9
Gilpin, H. E. (2011) · CommonKnowledge Research Repository (Pacific University Oregon)
Effectiviteit van behandelingen bij chronische lage rugpijn
van Tulder, M. W., & Koes, B. W. (2013) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-368-0277-2_5
Klassifikation af personer med uspecifikt lænderygbesvær
Kjær, P., Kongsted, A., Petersen, T., Larsen, K., Skytte, L., Ussing, K., & Enoch, F. (2012) · University of Southern Denmark Research Portal (University of Southern Denmark)
Kosteneffectiviteit van behandelingen van lage rugklachten
van Tulder, M. W., & Koes, B. W. (2013) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-368-0277-2_8
Targeting psychological factors: Is this a job for physiotherapists?
Woby, S. R. (2009) · International Journal of Therapy and Rehabilitation · doi:10.12968/ijtr.2009.16.1.37933
Foster, N. E. (2010) · Clinical Chiropractic · doi:10.1016/j.clch.2010.02.017
Nováková, E., & Král, P. (2012)
Umsetzung der Neuen Rückenschule – Praxisbeispiele
Kempf, H.-D. (2014) · Springer eBooks · doi:10.1007/978-3-662-43689-9_7
Pilates can decrease chronic low back pain and related functional disability
O’Brien, C. (2010) · Unitec Research Bank (Unitec Institute of Technology)
The transition from acute to chronic post-surgical pain – A prospective cohort study
MacLachlan, C. (2016) · Otago University Research Archive (University of Otago)
Jepson, P. (2016) · University of Birmingham Institutional Research Archive (University of Birmingham)
Cognitive and behavioural considerations in neuromuscular rehabilitation
Lederman, E. (2010) · Elsevier eBooks · doi:10.1016/b978-0-443-06969-7.00008-5
Dagenais, S., & Haldeman, S. (2011) · Elsevier eBooks · doi:10.1016/b978-0-323-07293-9.00002-7
Pain Management and ROM Desensitization
Lederman, E. (2013) · Elsevier eBooks · doi:10.1016/b978-0-7020-4318-5.00009-4
Exploring self-management of chronic low back pain in Saudi Arabia
Adem, A. (2017) · Sheffield Hallam University · doi:10.7190/shu-thesis-00014
Abramson, D. (2018) · Journal of Novel Physiotherapy and Physical Rehabilitation · doi:10.17352/2455-5487.000057
Back Schools and Fear Avoidance Training
Brox, J. I., Storheim, K., Grotle, M., Tveito, T. H., Indahl, A., & Eriksen, H. R. (2011) · Elsevier eBooks · doi:10.1016/b978-0-323-07293-9.00007-6
Ofner, M., Liebhauser, M., & Walach, H. (2019) · Complementary Medicine Research · doi:10.1159/000494458
Psychological and Behavioural Considerations in ROM Rehabilitation
Lederman, E. (2013) · Elsevier eBooks · doi:10.1016/b978-0-7020-4318-5.00011-2
Gardiner, S., Daniell, H., Smith, B. E., & Chester, R. (2020) · International Journal of Therapy and Rehabilitation · doi:10.12968/ijtr.2019.0109
Mowat, R. M., Lewis, G. N., & Borotkanics, R. (2021) · Australian Health Review · doi:10.1071/ah21018
(2011) · Elsevier eBooks · doi:10.1016/b978-0-7295-3908-1.10027-2
Postsurgical Dance Rehabilitation for Tibial Stress Fracture: 2 Case Reports
Nabeta, Y., Heineman, H., & Schanfein, L. (2022) · JOSPT Cases · doi:10.2519/josptcases.2022.10738
Social Return on Investment of Musculoskeletal Physiotherapy in the National Health Service
Russell, J. A., & Innes, S. (2024) · Musculoskeletal Care · doi:10.1002/msc.70008
Baumbach, L., Feddern, W., Kretzler, B., Hajek, A., & König, H.-H. (2024) · Figshare · doi:10.6084/m9.figshare.26706141
Kühn, L., Lindert, L., Kuper, P., Prill, R., & Choi, K.-E. (. (2023) · Figshare · doi:10.6084/m9.figshare.22605406
Kühn, L., Lindert, L., Kuper, P., Prill, R., & Choi, K.-E. (. (2023) · Figshare · doi:10.6084/m9.figshare.22605415
Baumbach, L., Feddern, W., Kretzler, B., Hajek, A., & König, H.-H. (2024) · Figshare · doi:10.6084/m9.figshare.26706138
Kühn, L., Lindert, L., Kuper, P., Prill, R., & Choi, K.-E. (. (2023) · Figshare · doi:10.6084/m9.figshare.22605409
Baumbach, L., Feddern, W., Kretzler, B., Hajek, A., & König, H.-H. (2024) · Figshare · doi:10.6084/m9.figshare.26706135
Kühn, L., Lindert, L., Kuper, P., Prill, R., & Choi, K.-E. (. (2023) · Figshare · doi:10.6084/m9.figshare.22605412
Szyszka, J., Matuska, J., Szyszka, B., Walkowiak, D., & Skorupska, E. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1805628
Metadata
- 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.
- Venue
- Spine
- Published
- 2007-06
- Volume
- 32
- Issue
- 14
- Pages
- 1474-1481
- ISSN
- 0362-2436 (ISSN-L)
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Orthopedics and Sports 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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