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At the heart of general practice since 1960

PCT restructures set to dilute GPs' voice

Intensive rehabilitation is as

effective as surgery for treating chronic low back pain and significantly cheaper, a new trial and accompanying economic analyis conclude.

The research, published online in the BMJ this week, has sparked calls for PCTs to make rehabilitation far more widely available.

The Medical Research Council team found little difference between spinal fusion surgery and a rehabilitation programme including cognitive behaviour therapy.

Surgery reduced the 100-point Oswestry disability index from 46.5 to 34.0 and rehabilitation from 44.8 to 36.1.

The researchers said the benefits of surgery were 'marginal' and did not justify the extra risks and costs.

Study leader Mr Jeremy Fairbank, honorary senior clinical lecturer in orthopae-dics at the University of Oxford, said: 'PCTs should be looking at ways of rehabilitating patients with chronic low back pain.'

Mr Fairbank, a consultant orthopaedic surgeon in Oxford, added: 'This is evidence that physical activity is a good thing, but lots of GPs do not always advocate that. From the GP's point of view it's important to realise that we have now got evidence that this is a good way of doing things.'

The researchers recruited 349 patients from 15 UK centres and compared the effectiveness of spinal fusion surgery and a three-week rehabilitation programme of education, exercise and CBT.

The related cost utility analysis found surgery cost £7,830 per patient but rehabilitation only £4,526. Surgery cost £48,588 more than rehabilitation per quality of life year gained ­ well above the threshold for cost-effectiveness.

Dr Peter Stott, a GP in Tadworth, Surrey, who has set up primary care services for low back pain, said: 'I think the findings of the study support what most musculoskeletal physicians believe, which is that physical treatment and extended scope physiotherapy with CBT have advantages over surgery.'

He added: 'We need to think of setting up appropriate services for managing these patients, rather than just sending them for orthopaedic surgery. GPs should have the confidence to say exercise is better for your back than surgery.'

By Nerys Hairon

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