Manipulative physiotherapy for spinal problems in primary care: outcomes of care

Outcome measures for physiotherapy in a primary health care setting should be evaluated before physiotherapy becomes widely available in general practice. The aim of this study was to assess changes in outcome measures in patients with spinal problems treated with bed rest, advice and analgesia ('traditional' treatment) and with manual/manipulative physiotherapy ('active' treatment). A retrospective analysis was carried out of computerized records of patients treated in primary care with manual and manipulative physiotherapy for spinal problems and a group with a similar age/sex/diagnosis profile who were given traditional treatment. Outcome measures in the 12 months following the initial diagnosis were: referrals, recurrences, casualty attendances, X-rays and number of prescribed analgesic and non-steroidal anti-inflammatory agents (NSAIDs). In the active group, there were 231 lumbar and 154 cervical patients, and 82 and 75, respectively, in the traditional group. There was a significant decrease in the recurrence rate [odds ratio (OR) = 0.56, 95% confidence interval (CI) 0.37-0.84] and in the numbers attending casualty (OR = 0.19, 95% CI 0.04-0.76) for 'active' compared with 'traditional' patients. For patients with cervical problems, there was a significant decrease in the active group of NSAIDs prescribed (P < 0.05). Certain outcomes of spinal problems are improved by the provision of manipulative physiotherapy in general practice.