Patient perceptions of physical therapy within a trial for back pain treatments (UK BEAM) [ISRCTN32683578]

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Abstract
Objectives. To explore the views of participants in a randomized controlled trial of physical treatments for low back pain about the treatment packages they received in the trial. Methods. Within a randomized controlled trial that found small to moderate benefits from adding a manipulation package or an exercise programme to general practice care, we elicited participants’ views on the treatment using an open question in participant questionnaires. These data were analysed using an adapted framework approach. Results. We received a total of 1259 comments from 1334 participants. Participants randomized to usual general practice care reported dissatisfaction with receiving only ‘usual care’, which consisted of providing analgesic medication without providing an explanation for their pain. Those randomized to a manipulation package felt the intervention was appropriate to their needs and commonly reported striking benefits. Participants assigned to the exercise programme developed a sense of self-reliance in managing back pain, although some failed to be sufficiently motivated to continue their exercise regimen outside the classes. Conclusions. This qualitative analysis has found much clearer differences between the groups than the main quantitative analysis. This suggests that some of the added value from being allocated to additional physical treatment for low back pain is not being captured by existing methods of measurement. Improved methods of assessment that consider a wider range of domains may be needed when interpreting the added value of such treatments to individual patients.