Early Intervention for the Management of Acute Low Back Pain

Benedict M. Wand, BAppSc, GradDip(ExSpSc), MAppSc, PhD; Christien Bird, MSc, MCSP; James H. McAuley, BSc, PgDip, PhD; Caroline J. Doré, BSc; Maureen MacDowell, MCSP; Professor Lorraine H. De Souza


Spine. 2004;29(21) 

In This Article


A total of 804 patients were considered for inclusion in the study. Following the application of the eligibility criteria, 102 (13%) patients were randomized to either the assess/advise/treat (n = 50) or the assess/advise/wait (n = 52) group (Figure 1). One patient from each group was excluded after randomization because of commencing litigation. Reasons for exclusion are presented in Table 1 .

Recruitment and follow-up of study participants.

A total of 65 patients (64%) at 6 weeks and 63 patients (62%) at long-term follow-up returned their assessments. There was no significant difference between the groups in the proportion of patients who returned questionnaires at either 6 week (χ2 = 1.75, P = 0.19) or long-term (χ2 = 0.004, P = 0.95) follow-up.

Following randomization, 6 patients failed to complete their baseline assessments and 2 patients were excluded because of commencing litigation. Baseline characteristics are presented in Table 2 for the 94 patients who provided baseline assessment. No significant differences were detected between groups at baseline (P > 0.05).

There was a significant (P < 0.05) effect of treatment on STAIS, RMDQ, MZSRDS, EuroQol Total Score, EuroQol Health Thermometer, SF-36 Vitality, SF-36 Social Functioning, and SF-36 Mental Health ( Table 3 ). Patients randomized to the assess/advise/treat group reported significantly lower disability and fewer symptoms of depression and anxiety and had better quality of life, vitality, social functioning, and mental health at 6 weeks than those patients randomized to the assess/advise/wait group.

There was a significant (P < 0.05) long-term effect of treatment on STAIS MZSRDS, MSPQ, EuroQol Health Thermometer, and SF-36 Role-Emotional, Mental Health, and Health Transition ( Table 4 ). Those patients in the assess/advise/treat group reported fewer symptoms of depression, somatic distress, and anxiety, had better quality of life and mental health, and reported less interference of emotional problems in everyday activities than those patients in the assess/advise/wait group.

The potential effects of missing data were explored by refitting the regression models (which assessed short- and long-term effects of treatment) with missing data replaced by the last value carried forward. Apart from VAS for usual pain intensity (short-term follow-up VAS was significantly lower for the assess/advise/treat group; regression coefficient = -1.2, SE = 0.5, P = 0.02), there were no other differences between these models and the regression models using all available data. Furthermore, there were no significant interactions between group and responder status for any baseline variable (P > 0.05).


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