Physiotherapy exercises and back pain: a blinded review.

OBJECTIVE: To determine the quality of randomised controlled trials of exercise therapy for back pain. DESIGN: Computer aided search of published papers and blinded assessment of the methods of studies. SUBJECTS: 23 randomised controlled trials, of which 16 studied exercise therapy given by physiotherapists to individual patients with back pain. Other conservative treatments could be included. MAIN OUTCOME MEASURES: Score for quality of methods (based on four main categories: study population, interventions, measurement of effect, and data presentation and analysis) and main conclusion of author(s) with regard to exercise therapy. RESULTS: Only four studies scored more than 50 points (maximum 100), indicating that most were of poor quality. Six studies found that exercise was better than reference treatments and 10 reported it to be no better or worse than the reference treatment. Those reporting positive results tended to have higher methods scores (4/6 positive v 4/10 negative scored greater than or equal to 42). CONCLUSIONS: No conclusion can be drawn about whether exercise therapy is better than other conservative treatments for back pain or whether a specific type of exercise is more effective. Further trials are needed in which greater attention is paid to methods of study.