Research Review by Dr. Shawn Thistle©



Study Title:

United Kingdom back pain exercise and manipulation (UK BEAM) randomized trial: cost effectiveness of physical treatments for back pain in primary care


UK BEAM Trial Team

Publication Information:

British Medical Journal 2004


In order to recommend a treatment in clinical practice based on solid scientific evidence two main criteria must be addressed. First, it must be determined if the treatment actually works.

Second, it must be ascertained whether the treatment is cost effective within whatever type of health care delivery framework is in use.

This study assessed the cost effectiveness of the physical treatments (manipulation, exercise, or a combination of the two) used to treat low back pain in private practice or NHS facilities in the United Kingdom. 

In this study, a complex analysis was done to equate how much would need to be spent on each treatment to provide a certain increase in "Quality Adjusted Life Years", or QALY, a commonly used indicator of the benefit of a particular treatment.

For those interested in the complete description of these methods, click the link in the Public Information section above for the full text of this article.

Conclusions & Practical Application:

As previously discussed, each treatment in this study provided benefit. What this part of the study adds is that spinal manipulation provided the biggest and most economical increase in QALY in the twelve month study period. As a result, the study group suggests that adding spinal manipulation to "best care" in general practice is effective, and cost efficient for patients with back pain.

The study group also added that spinal manipulation alone probably provided better value than manipulation followed by exercise. This may seem counter-intuitive to many of us in clinical practice, but I would suggest that this recommendation may change if the follow-up period was longer. This would allow a preventive aspect of exercise to perhaps alter the longer-term outcome as many of us see everyday.

Further studies are required in this area to clarify this question.