PERSISTANT LOW BACK PAIN

practice to: ■ ensure that your patients received best practice

■ demonstrate to your commissioners that your practice is evidence based.

GLOSSARY

For clarity a few terms used here need defining. ■ Manual therapy includes both massage and manipulative techniques i.e. interventions that involve therapists using their hands.

■ Manipulative techniques include both:

– Mobilisation – low-through-high amplitude passive movements applied to a joint

– Manipulation – high velocity, low amplitude passive movements applied to a joint.

■ McKenzie exercise – direction specific exercises to treat the symp- toms of LBP which is based on the McKenzie method of mechanical diagnosis and therapy.

Acknowledgements to those who worked on these guidelines Major contributors to the Guideline Development Group were Chris Mercer (chair), Dries Hettinga (systematic reviewer), Panos Barlos, Sarah Ferguson, Susan Greenhalgh, Vicki Harding, Deirdre Hurley Osing, Jennifer Klaber Moffett, Denis Martin, Stephen May, Jude Monteath, Lisa Roberts, Nia Taylor and Steve Woby. In addition the following should be acknowledged: members of the expert consensus group, numerous employees of the CSP’s Practice and Development function, and many other experts who gave their time freely to develop these guidelines.

THE AUTHOR Dr Anne Jackson was the Chartered Society of Physiotherapy’s (CSP) guidelines project manager responsible for these guidelines. Since their completion she has worked with the CSP’s Sharing Knowledge in Physiotherapy Practice (SKIPP) project team to devise new processes for develop- ing tools for physiotherapy practice. As a specialist in hydrotherapy Anne currently contributes to both developing hydrothera- py services and hydrotherapy research. Contact Anne at: jacksona@csp.org.uk

www.sportex.net 19

References 1. Airaksinen O, Bronx JI et al. European guidelines for the management of chronic non- specific low back pain. Published 2004 (cited 2005 www.backpaineurope.org) 2. Mercer C, Jackson A, et al.

Clinical guide-

lines for the physiotherapy management of per- sistent low back pain. Part 1: exercise and Part 2: manual therapy. Chartered Society of Physiotherapy 2006 3. van Tulder MW, Assendelft WJ, Koes BW, Bouter LM. Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for Spinal Disorders. Spine 1997;22(20):2323-2330 4. Klaber, Moffett J, Torgerson D, Bell Syer S et al. Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences. BMJ 1999;319(7205):279-283 5. UK BEAM trial team, United Kingdom back pain exercise and manipulation (UK BEAM) ran- domised trial: effectiveness of physical treat- ments for back pain in primary care. BMJ 2004;329(7479):1377 6. UK BEAM trial team, United Kingdom back pain exercise and manipulation (UK BEAM) ran- domised trial: cost effectiveness of physical treatments for back pain in primary care. BMJ 2004;329(7479):1381 7. Mannion AF, Muntener M, Taimela S, Dvorak J. A randomized clinical trial of three active therapies for chronic low back pain. Spine 1999;24(23):2435-2448 8. McIlveen B and Robertson VJ. A randomised controlled study of the outcome of hydrothera- py for subjects with low back or back and leg pain. Physiotherapy 1998;84(1):17-26 9. Murphy M, B.N., Lamping D, McKee C, Sanderson C, Askham J, Consensus develop-

ment methods, and their use in clinical guide- line development. Health Technology Assessment 1998;12(3) 10. Moore A. Jackson A, Jordan J et al. Clinical guidelines for the physiotherapy management of whiplash associated disorder. The Chartered Society of Physiotherapy 2005 11.National Institute of Clinical Excellence, Information for National Collaborating Centres and Guideline Development Groups 2001, National Institute for Clinical Excellence 2001 12. Jackson A, Barlos P, Ferguson S et al. Expert consensus evidence was combined with research evidence to develop clinically useful guidelines for people with persistent low back pain. World Conference of Physical Therapy, Vancouver, Canada 2007 13. Chartered Society of Physiotherapy, Making the Business Case: A Physiotherapist’s Guide to Commissioning. The Chartered Society of Physiotherapy 2007. ■ 2nd round voting ■ Carried out by email ■ Over a two week time period. ■ Discussion about each remaining statement (where less than 75% agreement)

■ Mean agreement/disagreement of the group was indicated for each question

■ Carried out by an electronic conferencing system

■ Over a two week time period ■ Consensus statements written where con- sensus was achieved (ie. 75% or more agreement)

■ 1st round voting ■ Carried out by email ■ Over a two week time period ■ Consensus statements written where consensus was achieved (ie. 75% or more agreement)