FROM:   British Medical Journal 2004 (Dec 11); 329 (7479) ~ FULL TEXT

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These 2 studies compared the benefits of spinal manipulation and exercise to “best care” in general practice for patients consulting for back pain. 1,287 patients were divided into treatment groups and followed for more than one year. Patients receiving manipulation and exercise had lower relative treatment costs and experienced more treatment benefits than those treated with general medical care. The authors believe that this study convincingly demonstrated that manipulation alone and manipulation followed by exercise provided cost-effective additions to general practice.

Spinal Manipulation Gives Value for Money: British Medical Research Council (MRC) Trial Finds Adding Spinal Manipulation and Exercise to GP Care Provides Relief (and Cost-effectiveness) for Back Pain

Most patients with acute back pain improve over time, but adding spinal manipulation followed by exercise to standard care moderately improves results. The UK BEAM trial team (page 1377) randomised 1,334 patients with low back pain to additional exercise classes, spinal manipulation, or manipulation followed by exercise or to "best care" in general practice. Manipulation, with or without exercise, improved symptoms more than best care (medical care) alone after three and 12 months. However, analysis of the cost utility of different strategies shows that manipulation alone probably gives better value for money than manipulation followed by exercise (page 1381).

United Kingdom Back Pain Exercise and Manipulation (UK BEAM) Trial

Effectiveness of Physical Treatments for Back Pain in Primary Care British Medical Journal 2004 (Dec 11); 329 (7479): 1377~ FULL TEXT Manipulation improves back function by a small to moderate margin at three months and a small but significant margin at 12 months; it also achieves sustained improvements in disability and pain, adverse back beliefs, and general physical health. Combined treatment improves back function by a moderate margin at three months and a small but significant margin at 12 months; generally it achieves little more than manipulation, except for much greater improvements in beliefs about back pain and fear avoidance

Cost Effectiveness of Physical Treatments for Back Pain in Primary Care British Medical Journal 2004 (Dec 11); 329 (7479): 1381 ~ FULL TEXT Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise. We believe that this is the first study of physical therapy for low back pain to show convincingly that both manipulation alone and manipulation followed by exercise provide cost effective additions to care in general practice. Indeed, as we trained practice teams in the best care of back pain, we may have underestimated the benefit of physical therapy (spinal manipulation) when compared with "usual care" in general practice. The detailed clinical outcomes reported in the accompanying paper reinforce these findings by showing that the improvements in health status reported here reflect statistically significant improvements in function, pain, disability, physical and mental aspects of quality of life, and beliefs about back pain. [1]

Other Articles About the UK BEAM Trial

	Commentary on the United Kingdom Evidence Report About the Effectiveness of Manual Therapies Chiropractic & Manual Therapies 2010 (Feb 25); 18 (1): 4 ~ FULL TEXT Bronfort et al [1] are to be congratulated on the production of this review of the clinical studies and systematic reviews of the scientific literature that have been published on the efficacy of the manual therapies and other treatments commonly offered by chiropractors. Although there are multiple other more detailed systematic reviews on the management of specific disorders I am not aware of any publication that has addressed the broader scope of manual therapy and chiropractic. His document should be of value to all chiropractors, medical physicians who work closely with chiropractors, as well as payers and health care policy makers. Although it is possible to argue over specific wording and disagree on the quality of some of the quoted studies in this document it is not possible to question the depth and scientific integrity of this work.
	The British Medical Research Council (MRC) Trial Finds Adding Spinal Manipulation and Exercise to GP Care Provides Relief for Back Pain The British Medical Research Council (MRC) ~ FULL TEXT Spinal manipulation, in the form of chiropractic, osteopathy or manipulative physiotherapy, followed by a program of exercise, provides significant relief of symptoms and improvements in general health, according to a trial by the Medical Research Council (MRC). The results of the trial were published November 19 in the online edition of British Medical Journal.
	UK Back pain Exercise And Manipulation (UK BEAM) Trial-- National Randomised Trial of Physical Treatments for Back Pain in Primary Care: Objectives, Design and Interventions BMC Health Serv Res 2003 (Aug 01); 3 (1): 16 ~ FULL TEXT The UK BEAM trial is a major trial of physical treatments for low back pain. Obtaining participation by members of the three physical therapy professions in the UK (chiropractic, osteopathy and physiotherapy) to work to an agreed treatment was an important achievement. Whatever the outcome of the trial, the results will inform the future management of low back pain both within the UK and internationally. The primary analysis will consider the main treatment effects before interactions between the two treatment packages. Economic analysis will estimate the cost per unit of health utility gained by adding either or both of the treatment packages to general practice care.
	Spinal Manipulation for Low-back Pain: A Treatment Package Agreed to by the UK Chiropractic, Osteopathy and Physiotherapy Professional Associations Manual Therapy 2003 (Feb); 8 (1): 46–51 Because the trial design specifically precluded comparison of the effect between the professions, it was necessary to devise a homogenous package representative of, and acceptable to, all three. The resulting package is 'pragmatic', in that it represents what happens to most people undergoing manipulation, and 'explanatory' in that it excludes discipline-specific variations and other ancillary treatments.

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