Individualised physiotherapy as an adjunct to guideline-based advice for low back disorders in primary care: a randomised controlled trial
Abstract
Background Many patients with low-back disorders persisting beyond 6 weeks do not recover. This study investigates whether individualised physiotherapy plus guideline-based advice results in superior outcomes to advice alone in participants with low-back disorders. Methods This prospective parallel group multicentre randomised controlled trial was set in 16 primary care physiotherapy practices in Melbourne, Australia. Random assignment resulted in 156 participants receiving 10 sessions of physiotherapy that was individualised based on pathoanatomical, psychosocial and neurophysiological barriers to recovery combined with guideline-based advice, and 144 participants receiving 2 sessions of physiotherapist-delivered advice alone. Primary outcomes were activity limitation (Oswestry Disability Index) and numerical rating scales for back and leg pain at 5, 10, 26 and 52 weeks postbaseline. Analyses were by intention-to-treat using linear mixed models. Results Between-group differences showed significant effects favouring individualised physiotherapy for back and leg pain at 10 weeks (back: 1.3, 95% CI 0.8 to 1.8; leg: 1.1, 95% CI 0.5 to 1.7) and 26 weeks (back: 0.9, 95% CI 0.4 to 1.4; leg: 1.0, 95% CI 0.4 to 1.6). Oswestry favoured individualised physiotherapy at 10 weeks (4.7; 95% CI 2.0 to 7.5), 26 weeks (5.4; 95% CI 2.6 to 8.2) and 52 weeks (4.3; 95% CI 1.4 to 7.1). Responder analysis at 52 weeks showed participants receiving individualised physiotherapy were more likely to imp…
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Individualised treatment is more effective than a rigid protocol.
“It has been proven that individualised treatment is more effective than a rigid protocol.15,16”
From Algorithm for Temporomandibular Disorders With Osteopathic Manipulative Therapy: An Expert Consensus (2025) · cites this paper as [16]
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Algorithm for Temporomandibular Disorders With Osteopathic Manipulative Therapy: An Expert Consensus
De-La-Iglesia, L., Bravo, C., Justribó-Manion, C., Montmany, A., Roman-Arias, T., Hue, I., Dugailly, P.-M., Colasanto, S., Van-Caille, P., & Rubí-Carnacea, F. (2025) · Journal of Chiropractic Medicine · doi:10.1016/j.jcm.2025.09.034 · Cited by 1 · see citing works
- Authors
- Ford, J. J., Hahne, A. J., Surkitt, L. D., Chan, A. Y. P., Richards, M. C., Slater, S. L., Hinman, R. S., Pizzari, T., Davidson, M., & Taylor, N. F.
- Affiliations
- La Trobe University (AU)
- The University of Melbourne (AU)
- Corresponding author
- Ford, Jon J
- ORCID
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2015-10-20
- Volume
- 50
- Issue
- 4
- Pages
- 237-245
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W1817679562
- Cited by
- 53
- References
- 8
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 3 · 2022: 6 · 2021: 6 · 2020: 2 · 2019: 4 · 2018: 5 · 2017: 6 · 2016: 7
- FWCI
- 4.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- La Trobe University
- National Health and Medical Research Council
- National Medical Research Council
- 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
- low back disorders, primary care, back pain, leg pain, activity limitation, Oswestry Disability Index, psychosocial factors, neurophysiological factors, treatment duration, responder analysis, chronic low back pain, cost-effectiveness
- MeSH terms
- Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Patient Education as Topic, Primary Health Care, Prospective Studies, Victoria, Treatment Outcome, Low Back Pain, Practice Guidelines as Topic, Physical Therapy Modalities, Young Adult, Precision Medicine
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