'Usual' physiotherapy is more effective than brief physiotherapy for neck pain.

Questions For patients with neck pain, is a brief physiotherapy intervention as effective as ‘usual’ physiotherapy? Do patient preferences for treatment influence outcome? Design Non-inferiority randomised controlled trial with concealed allocation and blinded assessors. Setting Eight community services in Yorkshire and Lincolnshire, UK, involving 28 participating physiotherapists (12 trained to provide brief intervention). Patients 268 patients (average age 48 years) with subacute/chronic neck pain, GP referred, randomly assigned to brief intervention (139) or ‘usual’ physiotherapy (129). Patient preference measured independently at baseline. Similar loss to follow-up at 12 months (17% and 18% respectively). Interventions Brief intervention of up to 3 treatments encouraging selfmanagement and early return to normal daily activities. ‘Usual’ care (variably electrotherapy, manual therapy, education, advice) determined by individual professional judgment. Outcomes Main outcome measure was Northwick Park neck pain questionnaire (NPQ), secondary outcome measures were SF-36 instrument, Tampa Kinesophobia Scale, Distress scale scored 0–10. All measures administered pre-intervention, 3 and 12 months follow-up. Results The results generally favoured ‘usual’ physiotherapy. NPQ showed significant difference at 12 months (1.99 (0.45 to 3.52)). Significant changes at 3 months in SF-36 domains of mental health (-4.68 (-8.37 to -0.98) and energy and fatigue (4.55 (-8.80 to -0.29), and at 12 months in SF-36 domains of Role Physical (-6.70 (-12.96 to -0.44)), Role Emotional (11.72 (-17.57 to -5.86)), Energy and Fatigue (-9.24 (-14.66 to -3.82)), Pain (-6.74 (-13.18 to -0.38)) and General Health (8.15 (-12.35 to -3.95)). Significant changes in Tampa scale at 3 months (-2.23 (-3.73 to -0.74)) favoured the brief intervention. Patients who preferred the brief intervention and received it had similar outcomes to patients receiving ‘usual’ physiotherapy. Conclusion ‘Usual’ physiotherapy was generally more effective than brief physiotherapy intervention at 3 and 12 months follow-up. The effect of patient preference on outcome is unclear.