Background & Purpose: This pragmatic randomised clinical trial (RCT) investigated differences in the clinical outcomes of physiotherapy for low back pain (LBP) delivered in

public hospital-based secondary care versus

Methods: Between March 2005 and May 2006, 160 consenting subjects [110F, 50M; mean age (SD) yrs: 41.28 (12.83)] were recruited, stratified (acute: < 3/12; chronic: > 3/12), and randomly allocated to public hospital (H) or private community (P) physiotherapy. Subjects completed clinical outcomes (Roland Morris Disability Questionnaire (RMDQ). SF-36, Fear Avoidance Beliefs & Back Beliefs Questionnaires) at baseline, 3, 6 and 12 months post randomisation and the Patient Satisfaction with Outpatient Physical Therapy (PTOPS) survey at the end of treatment. Intention-to-treat analysis was conducted using the Statistical Package for the Social Sciences (SPSS, Version 12).

Results: There were no significant differences between groups at baseline (p> 0.05). Patient response rates were 85% (n=137), 80% (n=128) and 74% (n=118) at 3, 6, and 12 months. Despite significantly longer waiting times for public hospital physiotherapy, repeated measures ANOVA found no significant differences over time between groups for any of the outcome measures (p> 0.05), except ‘patient satisfaction with outcome,’ which was significantly higher in the P group (median difference: 0.00; p=0.020, Mann Whitney U=1324.50).

Conclusions & Implications: The trial cannot recommend one physiotherapy setting over the other for LBP management. However, the limited adherence to LBP clinical guidelines in both settings and the lack of improvement in psychosocial outcomes in subjects managed in both settings warrant further investigation.

Acknowledgements: Physiotherapists, General practitioners and patients in both settings.

Background: This pragmatic randomised controlled trial aimed to investigate any differences in the clinical outcomes of patients with low back pain (LBP) receiving physiotherapy in (i) the current public hospital-based secondary healthcare model (H) versus (ii) a private community-based primary healthcare model (P)

Participants & Methods: Between March 2005 and May 2006, 160 consenting subjects [110F, 50M; mean age (SD) yrs: 41.28 (12.83}], referred by GPs for physiotherapy for non-specific LBP were recruited across three clinical centres within Ireland Subjects completed a baseline interview and outcome measures (Roland Morris Disability Questionnaire (RMDQ), SF-36 V2 Pain Subscale, Fear Avoidance Beliefs Questionnaire, Back Beliefs Questionnaire), were stratified (acute: < 3/12; chronic: > 3/12), and randomised to one of the two groups (i.e. H: n=80; P: n=80), with follow ups at 3, 6 and 12 months post randomisation.

Analysis: Data were coded and questionnaires scored, then analysed using the Statistical Package for the Social Sciences (SPSS, Version 11). An intention-to-treat analysis was conducted. Patient follow-ups are ongoing: 3-month [completed by 31stth August 2006; current response rate: 82% (n =117/143)].

Results: Both groups were comparable for all baseline demographic variables and questionnaire scores. Current descriptive analysis of mean change scores (SD), from baseline to 3-months, show clinically meaningful improvements in both groups RMDQ: [H=3.95(−1.172); P=4.94(−0.816)] and SF-36 Bodily pain: [H=−7.51(=3.6); P= −10.54(−2.6)]. The complete 3-month data set will be presented at the meeting.

Conclusion & Implications: The findings may influence future health policy regarding the funding of physiotherapy services in Ireland.