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Distinguishing Useful From Useless Therapy

Richard A. Deyo, MD, MPH

JAMA. 1983;250(8):1057-1062.

Abstract
Conservative therapies for low back pain (LBP) entail expense, work loss, and risk of side effects. Because many competing modalities have been advocated, 59 therapeutic trials were examined for adherence to 11 methodological criteria. Common problems included failure to randomize subjects, use "blind" observers, measure compliance, and adequately describe co-interventions. Applicability of many studies was unclear because of inadequate descriptions of patients, interventions, and relevant outcomes. Flexion exercises, administration of each of three drugs, one traction method, and certain manipulations were each supported by single studies of reasonable validity, but the importance of the results and their applicability to particular types of LBP were unclear. Valid trials supporting use of corsets, bed rest, transcutaneous nerve stimulation, and conventional traction were not found. Better methodological rigor is possible with newer techniques for ensuring blindness to therapy, measuring compliance, and assessing outcomes.

(JAMA 1983;250:1057-1062)

Author Affiliations
From the Division of General Internal Medicine, Department of Medicine, University of Texas Health Science Center, San Antonio.

Footnotes
The views and opinions expressed herein are those of the author and not necessarily those of the Robert Wood Johnson Foundation.

Reprint requests to Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78284 (Dr Deyo).

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