Objective: Systematic reviews show beneficial effects of spinal manipulation, general exercise and ‘active management’ on the part of general practitioners in the treatment of back pain. The objective of UK BEAM is to evaluate the effectiveness of these treatments for back pain.

Design: The UK BEAM trial is a national randomised factorial trial in primary care. Participants were randomised to receive GP active management, exercise classes, manipulation (in either private or NHS premises) or both exercise classes and manipulation.

Subjects: Participants were recruited from 150 GP practices in 14 centres distributed across the United Kingdom. The target population was patients between 18 and 65 years who present in general practice with non-specific back pain with or without leg pain. To avoid carry over effects participants would not have had physical therapy in he previous three months. To avoid participants who recover without specific treatment, participants were included in the trial only if their current episode had lasted at least four weeks. There was no upper limit to the duration of pain.

Outcome Measures: At baseline, one month, three months and twelve months participants completed questionnaires which included questions about general health, experience of back pain, beliefs about back pain, functional disability and costs to both the NHS and participants themselves.

Results: The trial recruited 1334 participants, of which 84% and 77% completed the one and three month questionnaires. At randomisation, the mean Roland Morris Disability Questionnaire (RDQ) score was 9.0 points (sd = 4.0). This improved to 6.8 points (sd = 4.8) at one month and to 5.5 points (sd = 5.0) at three months.

Conclusions: Preliminary blinded results show an improvement in RDQ scores across all participants. The primary analysis, available late 2002, will estimate he main effects of exercise and manipulation, each compared to GP care.