The UK BEAM trial - a review and discussion

The trial compared the 'best care' from General Practitioners (GPs) alone, against best care from GPs plus an exercise class, against best care from GPs plus a manipulation package, against a combination of all of these interventions (best care from GPs plus a manipulation package, followed by an exercise class). The results of the study showed a small, but statistically significant additional positive effect from the manipulation package, as well as smaller positive effects from the exercise package when each was compared to best care from GPs alone. The combination of all three interventions provided a slightly increased effect, but was found to be costly. Whether the size of these positive effects is clinically meaningful remains a point of discussion. Further studies of a more explanatory nature are called for, along with a need to use usual GP care as a control arm if future evaluations are to show the potential of these interventions to contribute to the care of back pain patients.