Physiotherapy compared with advice for low back pain
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《英国医生杂志》
EDITOR—The many responses to the randomised controlled trial of physiotherapy compared with advice for low back pain by Frost et al and the accompanying editorial by McAuley raised several issues.1 2 The general complaint was that trials are not always of good quality and therefore do not provide evidence for what works and what does not. Others added that the findings of the paper by Frost et al were not consistent with the conclusions so reports in the media had picked up the wrong message. And comparing treatment with something other than no treatment, one session with several sessions, and not considering the heterogeneity of the study sample, struck several as a pointless exercise.
The points raised in the debate between doctors, physiotherapists, and chiropractors and osteopaths were predictable, with people explaining their job profiles and discussing one profession's superiority or suitability over another. Some argued that the expense for a chiropractor or osteopath was money well spent, others that resources would be better spent on public education or early physiotherapy.
Many correspondents thought that patients needed much better information and education about how to deal with back pain and help themselves (by taking exercise and staying active, for example), others that general practitioners needed more training to be able to treat back pain successfully. Nutrition was seen as a crucial element in treating back pain. Better diagnoses based on a medical, orthopaedic approach were necessary, as was uncovering the underlying aetiology of back pain to inform treatment.
NHS treatment should be directed to protocols that are known to work. Respondents seemed fairly unanimous that mechanical treatment of back pain is one such. As one correspondent puts it, the message that hurt does not mean harm needs reinforcing. As does the fact that treatment for short term back pain should enable patients to recover from acute episodes and is not necessarily the same as treatment for chronic problems.
Birte Twisselmann, technical editor BMJ
Competing interests: None declared.
References
Electronic responses. Back pain and physiotherapy. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/329/7468/694 (accessed 2 Dec 2004).
Electronic responses. Randomised controlled trial of physiotherapy compared with advice for low back pain. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/329/7468/708 (accessed 2 Dec 2004).
The points raised in the debate between doctors, physiotherapists, and chiropractors and osteopaths were predictable, with people explaining their job profiles and discussing one profession's superiority or suitability over another. Some argued that the expense for a chiropractor or osteopath was money well spent, others that resources would be better spent on public education or early physiotherapy.
Many correspondents thought that patients needed much better information and education about how to deal with back pain and help themselves (by taking exercise and staying active, for example), others that general practitioners needed more training to be able to treat back pain successfully. Nutrition was seen as a crucial element in treating back pain. Better diagnoses based on a medical, orthopaedic approach were necessary, as was uncovering the underlying aetiology of back pain to inform treatment.
NHS treatment should be directed to protocols that are known to work. Respondents seemed fairly unanimous that mechanical treatment of back pain is one such. As one correspondent puts it, the message that hurt does not mean harm needs reinforcing. As does the fact that treatment for short term back pain should enable patients to recover from acute episodes and is not necessarily the same as treatment for chronic problems.
Birte Twisselmann, technical editor BMJ
Competing interests: None declared.
References
Electronic responses. Back pain and physiotherapy. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/329/7468/694 (accessed 2 Dec 2004).
Electronic responses. Randomised controlled trial of physiotherapy compared with advice for low back pain. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/329/7468/708 (accessed 2 Dec 2004).