Lorimer Moseley 

The University of Queensland and Royal Brisbane Hospital 

Manual therapy, exercise and education target distinct aspects of chronic low back pain and probably have distinct effects. 

This study aimed to determine the efficacy of a combined physiotherapy treatment that comprised all of these strategies.By 

concealed randomisation, 57 chronic low back pain patients were allocated to either the four-week physiotherapy program or 

management as directed by their general practitioners. The dependent variables of interest were pain and disability. 

Assessors were blind to treatment group. Outcome data from 49 subjects (86%) showed a significant treatment effect.The 

physiotherapy program reduced pain and disability by a mean of 1.5/10 points on a numerical rating scale (95% CI 0.7 to 2.3) 

and 3.9 points on the 18-point Roland Morris Disability Questionnaire (95% CI 2 to 5.8) , respectively.The number needed to 

treat in order to gain a clinically meaningful change was 3 (95% CI 3 to 8) for pain, and 2 (95% CI 2 to 5) for disability. A 

treatment effect was maintained at one-year follow-up.The findings support the efficacy of combined physiotherapy treatment 

in producing symptomatic and functional change in moderately disabled chronic low back pain patients.[Moseley L (2002): 

Combined physiotherapy and education is efficacious for chronic low back pain. Australian Journal of 

Physiotherapy 48:297-302]