Abstract
Background: Systematic reviews in back pain suggest beneficial effects from spinal manipulation, general exercise, and ‘active management’. These approaches have not been tested rigorously in the UK National Health Service. The UK BEAM trial was designed to evaluate such treatments for back pain in primary care. This paper describes the manipulation package used in the trial and the frequency with which the different elements of the package were delivered by therapists.
Methods/Results: At over 150 UK practices, patients consulting GPs with back pain were identified. Eligible and consenting patients were then randomised to receive one of GP active management, manipulation (either in NHS or private premises), exercise classes or both manipulation and exercise. Manipulation was delivered either by a chiropractor, an osteopath, or a physiotherapist. A package of manipulative care, agreed by the three professions, was developed, and practitioners could choose elements from the package within broad constraints.
The trial recruited 1334 participants, across 14 centres. Participants who received manipulation alone attended on average 6.5 sessions compared with 5.2 sessions when receiving manipulation combined with exercise. A ‘results embargo’ precludes detailed results prior to the conference, but we shall present findings about the pattern of delivery of the various elements of the manipulation package for these treatments, within NHS or private premises, and whether delivered by a chiropractor, an osteopath, or a physiotherapist.
Conclusion: Participants received more treatment sessions when randomised to manipulation alone compared with manipulation and exercise. This may be due to differences in the duration of treatment periods, which affected both clinician and patient availability. Findings will also show if there is variation in the delivery of manipulation depending on the treatment package, setting and profession. We shall use these data in the secondary analysis to determine the extent to which they explain variation in treatment effects.
Correspondence should be addressed to the editorial secretary: Dr Charles Pither, c/o British Orthopaedic Society, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN.
