The DOI matches its Crossref record; 41 of the 43 references it cites were found in a registry or an index.
Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial
Open accessAbstract
OBJECTIVES: To assess the clinical effectiveness of surgical stabilisation (spinal fusion) compared with intensive rehabilitation for patients with chronic low back pain. DESIGN: Multicentre randomised controlled trial. SETTING: 15 secondary care orthopaedic and rehabilitation centres across the United Kingdom. PARTICIPANTS: 349 participants aged 18-55 with chronic low back pain of at least one year's duration who were considered candidates for spinal fusion. INTERVENTION: Lumbar spine fusion or an intensive rehabilitation programme based on principles of cognitive behaviour therapy. MAIN OUTCOME MEASURE: The primary outcomes were the Oswestry disability index and the shuttle walking test measured at baseline and two years after randomisation. The SF-36 instrument was used as a secondary outcome measure. RESULTS: 176 participants were assigned to surgery and 173 to rehabilitation. 284 (81%) provided follow-up data at 24 months. The mean Oswestry disability index changed favourably from 46.5 (SD 14.6) to 34.0 (SD 21.1) in the surgery group and from 44.8 (SD14.8) to 36.1 (SD 20.6) in the rehabilitation group. The estimated mean difference between the groups was -4.1 (95% confidence interval -8.1 to -0.1, P = 0.045) in favour of surgery. No significant differences between the treatment groups were observed in the shuttle walking test or any of the other outcome measures. CONCLUSIONS: Both groups reported reductions in disability during two years of follow-up, possibly unrelated to the interventions. The statistical difference between treatment groups in one of the two primary outcome measures was marginal and only just reached the predefined minimal clinical difference, and the potential risk and additional cost of surgery also need to be considered. No clear evidence emerged that primary spinal fusion surgery was any more beneficial than intensive rehabilitation.
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“Although trials do not tend to report adverse effects or deterioration (such as worsening of depression to a level of clinical concern), we know that such effects should be small (Fairbank 2005;Hellum 2011;Morley 2008), so the treatment can be considered to be safe, with the reservation that the reasons for discontinuing treatment are rarely given and may be due to hidden adverse effects.”
From Psychological therapies for the management of chronic pain (excluding headache) in adults (2012) · cites this paper as Fairbank 2005
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“Treatment gains are of the same order as those of other available treatments (Glombiewski 2010), as shown by head-to-head trials of surgery versus psychologically based rehabilitation (Fairbank 2005;Hellum 2011).”
From Psychological therapies for the management of chronic pain (excluding headache) in adults (2012) · cites this paper as Fairbank 2005
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Citations
Cites
Fairbank, J. C. T., & Pynsent, P. B. (2000) · Spine · doi:10.1097/00007632-200011150-00017 · Cited by 5,851
Multiple Imputation of Missing Values
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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
Competing interests: none declared.
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United States Trends in Lumbar Fusion Surgery for Degenerative Conditions
Deyo, R. A., Gray, D. T., Kreuter, W., Mirza, S. K., & Martin, B. I. (2005) · Spine · doi:10.1097/01.brs.0000166503.37969.8a · Cited by 996
Multidisciplinary rehabilitation for chronic low back pain: systematic review
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Research works printed but not linked: 3
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- Nuffield Orthopaedic Centre, Oxford OX3 7LD Jeremy Fairbank consultant orthopaedic surgeon James Wilson-MacDonald consultant orthopaedic surgeon Karen Barker director of physiotherapy research University of Warwick, Division of Health in the Community, Coventry CV4 7AL Helen Frost research fellow Centre for Statistics in Medicine, Oxford OX3 7LF Ly-Mee Yu statistician Clinical Trial Service Unit and Epidemiological Studies Unit, Radcliffe Infirmary, Oxford OX2 6HE Rory Collins professor Correspondence to: J Fairbank jeremy.fairbank@ndos.ox.ac.uk
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The biopsychosocial approach to chronic pain: Scientific advances and future directions.
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007) · Psychological Bulletin · doi:10.1037/0033-2909.133.4.581 · Cited by 3,392
“These findings were similar to those of the Fairbank et al. (2005) research study, which reported outcomes at 2 years.”
ResultChou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Shekelle, P., Owens, D. K., & for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians and the American College of Physicians/American Pain Society Low Back Pain Guidelines Panel* (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-7-200710020-00006 · Cited by 2,718
Chapter 4 European guidelines for the management of chronic nonspecific low back pain
Airaksinen, O., Brox, J. I., Cedraschi, C., Hildebrandt, J., Klaber-Moffett, J., Kovacs, F., Mannion, A. F., Reis, S., Staal, J. B., Ursin, H., et al. (2006) · European Spine Journal · doi:10.1007/s00586-006-1072-1 · Cited by 2,594
Balagué, F., Mannion, A. F., Pellisé, F., & Cedraschi, C. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60610-7 · Cited by 1,961
Psychological therapies for the management of chronic pain (excluding headache) in adults
Williams, A. C. D. C., Eccleston, C., & Morley, S. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007407.pub3 · Cited by 1,634
Metadata
- Authors
- Fairbank, J., Frost, H., Wilson-MacDonald, J., Yu, L.-M., Barker, K., & Collins, R.
- Affiliations
- Nuffield Orthopaedic Centre (GB)
- University of Warwick (GB)
- University of Oxford (GB)
- Corresponding author
- Fairbank, Jeremy
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2005-05-23
- Volume
- 330
- Issue
- 7502
- Pages
- 1233
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC558090
- OpenAlex
- W2117632584
- Cited by
- 514
- References
- 43
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 9 · 2023: 11 · 2022: 16 · 2021: 11 · 2020: 8 · 2019: 18 · 2018: 11 · 2017: 25 · 2016: 25 · 2015: 31 · 2014: 25 · 2013: 38 · 2012: 28
- FWCI
- 25.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, cc-by-nc)
- Stirling Online Research Repository (University of Stirling) (submittedVersion, cc-by-nc)
- Research Output (Edinburgh Napier University) (submittedVersion, cc-by)
- HighWire Press Open Archive (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 › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- chronic low back pain, lumbar fusion, spinal stabilization, intensive rehabilitation, cognitive behavioral therapy, Oswestry Disability Index, disability, walking capacity, SF-36
- MeSH terms
- Adolescent, Adult, Chronic Disease, Female, Humans, Male, Middle Aged, Patient Compliance, Spinal Fusion, Cognitive Behavioral Therapy, Treatment Outcome, Low Back Pain
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