The DOI matches its Crossref record; 16 of the 16 references it cites were found in a registry or an index.
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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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
Mayer, T. G. (1987) · JAMA · doi:10.1001/jama.258.13.1763 · Cited by 482
Management of Nonspecific Low Back Pain by Physiotherapists in Britain and Ireland
Foster, N. E., Thompson, K. A., Baxter, D. G., & Allen, J. M. (1999) · Spine · doi:10.1097/00007632-199907010-00011 · Cited by 294
Back Schools for Nonspecific Low Back Pain
Heymans, M. W., van Tulder, M. W., Esmail, R., Bombardier, C., & Koes, B. W. (2005) · Spine · doi:10.1097/01.brs.0000182227.33627.15 · Cited by 235
Hay, E. M., Mullis, R., Lewis, M., Vohora, K., Main, C. J., Watson, P., Dziedzic, K., Sim, J., Lowe, C., & Croft, P. R. (2005) · The Lancet · doi:10.1016/s0140-6736(05)66696-2 · Cited by 199
UK BEAM Trial Team (2004) · BMJ · doi:10.1136/bmj.38282.607859.ae · Cited by 197
Quantifying stochastic uncertainty and presenting results of cost-effectiveness analyses
Glick, H. A., Briggs, A. H., & Polsky, D. E. (2001) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/14737167.1.1.25 · Cited by 113
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
van Middelkoop, M., Rubinstein, S. M., Kuijpers, T., Verhagen, A. P., Ostelo, R., Koes, B. W., & van Tulder, M. W. (2010) · European Spine Journal · doi:10.1007/s00586-010-1518-3 · Cited by 728
Searle, A., Spink, M., Ho, A., & Chuter, V. (2015) · Clinical Rehabilitation · doi:10.1177/0269215515570379 · Cited by 555
Exercise therapy for chronic nonspecific low-back pain
van Middelkoop, M., Rubinstein, S. M., Verhagen, A. P., Ostelo, R. W., Koes, B. W., & van Tulder, M. W. (2010) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2010.01.002 · Cited by 513
Exercise therapy for chronic low back pain
Hayden, J. A., Ellis, J., Ogilvie, R., Malmivaara, A., & van Tulder, M. W. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009790.pub2 · Cited by 589
Lamb, S. E., Hansen, Z., Lall, R., Castelnuovo, E., Withers, E. J., Nichols, V., Potter, R., & Underwood, M. R. (2010) · The Lancet · doi:10.1016/s0140-6736(09)62164-4 · Cited by 393
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
