Focus group methodology was used to explore the experiences, beliefs and treatment expectations of chronic low back pain (LBP) patients in order to identify what components of treatment they considered to be of most value: specific emphasis was placed on the importance of advice and exercise to these patients.

Methods: Using a purposive sampling procedure, three focus groups were convened. All participants (n=18) were currently experiencing chronic LBP (> 3months), with no red flags, and had received advice and exercise as part of treatment. Each group was facilitated by an independent moderator, and guided by a series of pre-determined questions, although participants were encouraged to freely air their personal opinions. Discussions were tape-recorded and transcribed, with the written consent of all participants. Transcribed data were categorised into a series of ‘nodes’ from which a series of common themes emerged.

Results: A variety of occupations and age groups were represented; one group consisted solely of females, and the other two were of mixed gender. The appropriateness of treatment was largely weighted upon the provision of a precise diagnosis. Participants acknowledged the value of advice and exercise provided by practitioners, however their lack of compliance with such programmes was a key factor limiting their long-term self-management of symptoms.

Conclusions: Clinical practice must incorporate strategies to improve compliance with advice and exercise. Individually tailored treatment programmes with follow-up support and direction, along with a better understanding of the physical and emotional impact of chronic LBP by practitioners, is recommended by patients.

Purpose of study: To test the relative effectiveness of interferential therapy (IFT) and manipulative therapy (MT) when used as sole treatments and in combination for the management of acute low back pain (ALBP). Although IFT is the most widely used electrotherapeutic modality in Britain and Ireland for the physiotherapeutic management of patients with LBP, often in combination with MT, its evidence base is weak and limited.

Methods: In this assessor-blinded RCT, consenting subjects recruited from 4 NHS hospitals (n=240) were randomised to receive (1) MT (n=80), (2) IFT (n=80)¹ or (3) combined MT and IFT (n=80), as well as a copy of the Back Book. Subjects completed the Roland Morris Disability Questionnaire (primary outcome), VAS, McGill Pain Questionnaire, EuroQol, SF-36 and a range of patient-related variables (secondary outcomes) at baseline, discharge (n=194, 83%), 6 months (n=166, 71%) and 12 months (n=158, 67%).

Results: There were significant improvements in all outcomes at discharge, which were not significantly different from the 6 month and 12 month values for the whole sample. Univariate analysis of covariance detected significant differences between groups in the mean adjusted change scores for SF-36 Physical Functioning (P = 0.03), Bodily Pain (P=0.04), and Mental Health (P = 0.03) scales at 12 months in favour of combined MT and IFT over MT. Although not statistically significant the trend of the change score data for the remaining pain outcomes suggested that subjects in the MT group deteriorated after discharge while those in the IFT and combined therapy groups displayed a more gradual improvement over the follow-up period, such that the MT group outcomes were poorer at 12 months.

Conclusions: The results provide some evidence for the continued use of IFT for short and long-term improvements in function and LBP particularly when used in combination with MT. However, MT alone was less effective for long-term improvements in pain.