Treatment preference changes after exposure to treatment in adults with chronic low back pain.

Only 83 of the 154 people in the original trial rated their treatment afterwards, because the questionnaire was added partway through. The authors report no baseline differences between those who did and did not complete it, but the sample is smaller than the trial. Ratings were taken only once after treatment, at 12 months, so the study cannot say when opinions shifted or whether they were changed by experiences outside the trial. The study was not designed to test whether change in pain or disability relates to change in preference, so the finding that disability was unrelated should not be read as proof that disability does not matter. Everyone could stand and walk unaided, had a body mass index of 30 or under, and had no pain below the knee, so the findings may not apply to people with more complex or disabling low back pain. Before treatment almost nobody preferred MST (0% of the MST group and 3% of the SFE group), so its ratings started from a low base. Only two exercise programmes were compared, each delivered by its own therapists who knew which treatment they were giving, so the results cannot be generalised to other low back pain treatments.

The trial was supported by NIH funding and one author was supported by an NIH grant during the study. One author reported grant funding from the NIH, the Academy of Orthopaedic Physical Therapy and Advance Healthcare (Australia), and a position on the board of trustees of the Foundation for Physical Therapy Research during the study. Another reported grants unrelated to this work, and two reported no conflicts. No company selling either treatment was involved.

Do not read the rise in motor skill training ratings as evidence that it works better than strength and flexibility exercise. This study measured how people rated the two treatments, not how much their pain or disability improved, and it was a secondary analysis of 83 of the 154 trial participants that was not designed to test these relationships.