Abstract
Objective: To explore the views of patients’ differing treatments received within a randomised controlled trial of physical treatments for low back pain.
Methods: Within a randomised controlled trial, that found small to moderate benefits from adding a manipulation package or an exercise programme to General Practice care, we elicited participants’ views on their treatment from free text responses to an open question completed by respondents at the end of baseline and follow-up questionnaires. These data were organised and analysed using an adapted ‘Framework’ approach.
Results: We received a total of 1,259 comments from 1,334 participants. Participants randomised to general practice care reported dissatisfaction with only receiving ‘usual care’ that consisted of no more that providing analgesic medication without providing an explanation for their pain. Those randomised to a manipulation package felt the intervention was appropriate to their needs, commonly reporting quite striking benefits. Participants assigned to the exercise programme developed a sense of self reliance in managing back pain although some failed to be sufficiently motivated to continue their exercise regimen outside of the classes.
Conclusions: This qualitative analysis has found much more dramatic differences between the groups than the main quantitative analysis. This suggests that some of the ‘value added’ to general practice care from being allocated to additional physical treatment for low back pain is not being captured by existing methods of measurement. Improved methods of assessment that consider a wider range of domains may be needed when interpreting the added value to individual patients of such treatments.
Correspondence should be addressed to Ms Alison McGregor, c/o BOA, SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
