Evidence map›Paper›PMID 15556954›Full record

Trial reportBMJ (Clinical research ed.)2004

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care.

UK BEAM Trial Team

Open access · bronzeAbstract readClinical TrialMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
57citing papers in PubMed, 13 pooled it
14.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

57 citing papers in PubMed, 13 syntheses or guidelines pooled it, 203 citations in OpenAlex.

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  7. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain.The Cochrane database of systematic reviews · 2014
    Pooled it
  8. Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2011
    Pooled it
  9. Cost-effectiveness of general practice care for low back pain: a systematic review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2011
    Pooled it
  10. Are physical activity interventions in primary care and the community cost-effective? A systematic review of the evidence.The British journal of general practice : the journal of the Royal College of General Practitioners · 2011
    Pooled it
  11. Spinal manipulative therapy for chronic low-back pain.The Cochrane database of systematic reviews · 2011
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

1 author.

UK BEAM Trial Team

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain.

designStochastic cost utility analysis alongside pragmatic randomised trial with factorial design.

setting181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom.

participants1287 (96%) of 1334 trial participants.

main outcome measuresHealthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months.

resultsOver one year, mean treatment costs relative to "best care" were 195 pounds sterling (360 dollars; 279 euros; 95% credibility interval 85 pounds sterling to 308 pounds sterling) for manipulation, 140 pounds sterling (3 pounds sterling to 278 pounds sterling) for exercise, and 125 pounds sterling (21 pounds sterling to 228 pounds sterling) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost 3800 pounds sterling; in economic terms it had an "incremental cost effectiveness ratio" of 3800 pounds sterling. Manipulation alone had a ratio of 8700 pounds sterling relative to combined treatment. If the NHS was prepared to pay at least 10,000 pounds sterling for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of 8300 pounds sterling relative to best care.

conclusionsSpinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.

Indexed as

AdultBack PainCombined Modality TherapyCost-Benefit AnalysisExercise TherapyFemaleFollow-Up StudiesHumansMaleManipulation, SpinalPrivate SectorPublic SectorQuality-Adjusted Life YearsTreatment Outcome

Identifiers

PMID15556954
PMCPMC535455
OpenAlexW2528466831

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.