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Giving patients choice in back pain does not improve outcome

‘Physiotherapist knows best’ may be the best option for people suffering from back pain, according to research from the University of Warwick.

Researchers at Warwick Medical School carried out a study to find out if offering back pain patients attending a physiotherapy department better information on treatment choices had any effect on the outcome. The study was funded by the National Institute for Health Research (NIHR).

In a paper, published in BMC Musculoskeletal Disorders, a cohort of 148 patients waiting for treatment for back pain were split into two groups. One group was given the usual NHS care, where their physiotherapist made a choice of treatment. The second group had an additional decision support package to help them choose their treatment. They were sent a booklet outlining the treatments available and evidence of effectiveness and then consulted a physiotherapist, who was trained in shared informed decision making.

The research team found the intervention made no difference to satisfaction with treatment (the main outcome from the study) between the two groups. Worryingly, those who received the additional information and were more involved in treatment decisions were more seriously affected by their back pain (as measured by a back pain disability questionnaire) at the end of the treatment than the usual care group.

Lead author, Dr Shilpa Patel said: “We are not sure why better information appears to be detrimental. It may be that a more traditionally directive approach to treatment choices from a physiotherapist improves how well treatments work. What it does show, is that decision support packages should be formally tested for clinical and cost-effectiveness, as well as safety, before implementation in practice.”

The research team included colleagues from the University of Warwick, University of Oxford, Brunel University, University Medical Center Göttingen and University of Technology Sydney.

Notes to Editors

The paper, Primum non nocere: Shared informed decision making in low back pain – A pilot cluster randomised trial is available online

The study was funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Ref - PB-PG-0808-17039).

The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website.

To arrange an interview with Professor Martin Underwood/Dr Shilpa Patel, please contact Kelly Parkes-Harrison, Senior Press and Communications Manager,, 02476 150868, 07824 540863.

To speak to the research team, contact Kelly Parkes-Harrison, Senior Press and Communications Manager,, 02476 150868, 07824 540863

The paper is available online: Primum non necere: Shared informed decision making in low back pain