A survey of 86 UK Physiotherapy Departments indicated that the most commonly used forms of therapy for low back pain included exercises, short wave diathermy and traction. A prospective randomized single blind parallel group therapeutic trial was organized to include the three above treatment groups and a subthermal short wave diathermy control group. 579 patients referred from general practice to a Rheumatology Out Patient Department were screened until 400 patients had been entered into the trial. Treatments were given three times a week for 2 weeks and the patients were then seen in the follow up clinic for assessment. There were no significant differences between the four treatment groups in the subjective opinions of the patients on benefit (0.3 < p < 0.4). It was postulated that within this series of patients there might be cases with distinctive patterns of back pain which could be shown to respond differently to the forms of treatment under study. 301 of the patients from the therapeutic trial had data suitable for a classification analysis in which seven distinct patterns of low back pain were recognized. The hypothesis was confirmed when testing nine treatment outcome measures for interaction between the four treatment groups and the seven patterns of back pain when a multivariate significance level of p = 0.02 was obtained. This indicated that there was a treatment effect summarizing different responses, dependent on the 'diagnoses'. For example, traction seemed to be most appropriate for patients with the type 5 pattern in which patients described a paradox referred to as 'contralateral' in which their low back pain at rest is on one side and yet tests prove tender or induce pain on the opposite side.

Full text (sometimes free) may be available at these link(s):      help

• PDF locator