Rheumatology Advance Access originally published online on October 24, 2006
Rheumatology 2006 45(12):1514-1521; doi:10.1093/rheumatology/kel339
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Randomized trial of two physiotherapy interventions for primary care neck and back pain patients: ‘McKenzie’ vs brief physiotherapy pain management
1Institute of Rehabilitation, University of Hull, 2York Trials Unit, Department of Health Sciences, University of York, 3Hull and East Yorkshire NHS Hospital Trust, Hull, 4Oncology Health Centres, Hull and East Yorkshire Hospitals NHS Trust, 5Sheffield Hallam University, Sheffield and 6Physiotherapy Department, Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, UK.
Correspondence to: Jennifer Klaber Moffett, Deputy Director, Institute of Rehabilitation, 215, Anlaby Road, University of Hull, Hull, UK. Email: j.k.moffett{at}hull.ac.uk
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Abstract |
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Objectives. Interventions that take psychosocial factors into account are recommended for patients with persistent back or neck pain. We compared the effectiveness of a brief physiotherapy pain management approach using cognitive–behavioural principles (Solution-Finding Approach—SFA) with a commonly used method of physical therapy (McKenzie Approach—McK).
Methods. Eligible patients referred by GPs to physiotherapy departments with neck or back pain lasting at least 2 weeks were randomized to McK (n= 161) or to SFA (n= 154). They were further randomized to receive an educational booklet or not. The primary outcome was the Tampa Scale of Kinesiophobia (TSK) (Activity-Avoidance scale used as a proxy for coping) at 6 weeks, and 6 and 12 months.
Results. Of 649 patients assessed for eligibility, 315 were recruited (219 with back pain, 96 with neck pain). There were no statistically significant differences in outcomes between the groups, except that at any time point SFA patients supported by a booklet reported less reliance on health professionals (Multidimensional Health Locus of Control Powerful Others Scale), while at 6 months McK patients showed slightly more improvement on activity-avoidance (TSK). At 6 weeks, patient satisfaction was greater for McK (median 90% compared with 70% for SFA). Both interventions resulted in modest but clinically important improvements over time on the Roland Disability Questionnaire Scores and Northwick Park Neck Pain Scores.
Conclusions. The McK approach resulted in higher patient satisfaction overall but the SFA could be more cost-effective, as fewer (three vs four) sessions were needed.
KEY WORDS: Physical therapy, Neck pain, Back pain, Randomized trial, Primary care
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  A. Manca, J. C. Dumville, D. J. Torgerson, J. A. Klaber Moffett, M. P. Mooney, D. A. Jackson, and S. Eaton Randomized trial of two physiotherapy interventions for primary care back and neck pain patients: cost effectiveness analysis Rheumatology, September 1, 2007; 46(9): 1495 - 1501. [Abstract] [Full Text] [PDF]
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