Rheumatology Advance Access originally published online on December 14, 2007
Rheumatology 2008 47(2):231-232; doi:10.1093/rheumatology/kem325
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Comment on: Do baseline characteristics predict response to treatment for low back pain? Secondary analysis of the UK BEAM dataset: reply
Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
Correspondence to: M. Underwood. E-mail: m.underwood{at}warwick.ac.uk
SIR, Sweetman [1] correctly draws our attention to the possibility of alternative participant characteristics that could predict response to specific treatments for patients with low back pain. In the UK Back Pain Exercise and Manipulation (BEAM) trial, we did not include any physical assessments of its participants [2]. Since the variables we used in our analysis of predictors of response to treatment explained less than a third of the variance in outcome there must be other factors that predict outcome for patients with low back pain [3]. The results of physical examination may be a predictive factor that should be included in future studies of predictors of response to treatment. The question is then, which physical measure should be included? There are champions advocating the use of a range of individual physical assessments to predict response to treatment. None of these has yet achieved widespread acceptance. Expert groups from 11 countries worked to develop a Multinational Musculoskeletal Inception Cohort Study (MMICS) statement for recommended baseline measures to include in future cohort studies [4]. They did not include any physical measure in the recommended packages. Thus, more work is needed to find out if there are any physical measures that may be worth including as explanatory variables in future intervention studies.
There is some evidence that some treatments for back pain can have small mean to moderate beneficial effects; which probably means that some patients get a meaningful benefit and that some have little or no benefit. The challenge is to work out who is likely to gain the greatest benefit from which treatment. To do this, new studies are needed, which are designed with the express intention of predicting who responds to defined effective treatment packages.
Disclosure statement: The author has declared no conflicts of interest.
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- Sweetman BJ. Comment on: Do baseline characteristics predict response to treatment for low back pain? Secondary analysis of the UK BEAM dataset. In: Rheumatology (2007) Dec 3. [Epub ahead of print] doi:10.1093/rheumatology/kem305.
- UK BEAM Trial Team. UK Back pain Exercise And Manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. Br Med J (2004) 229:1377–81.
- Underwood MR, Morton V, Farrin A, on behalf of the UK BEAM trial team. Do baseline characteristics predict response to treatment for low back pain? Secondary analysis of the UK BEAM dataset [ISRCTN32683578]. Rheumatology (2007) 46:1297–30.
[Abstract/Free Full Text] - Pincus T, Santos R, Breen A, Burton AK, Underwood MR, on behalf of the MMICS collaboration. A review and proposal for a core set of factors for prospective cohorts in back pain; the MMICS Statement. In: Arthritis Rheum. In press.
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