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February 22, 1985

Treatment of Low-Back Pain

Author Affiliations

MRC Epidemiology and Medical Care Unit Northwick Park Hospital Middlesex, England

JAMA. 1985;253(8):1122. doi:10.1001/jama.1985.03350320042012

To the Editor.—  The article by Dr Richard A. Deyo1 reviews a number of trials of treatment for low-back pain, including our multicenter trial2 of physiotherapy in the management of sciatic symptoms. Dr Deyo's assessment of the trials under consideration involved a number of assumptions and arbitrary decisions that, coupled with the omission of any mention of one of its central features, have given a misleading impression of our trial.First, Dr Deyo implies that assessment of outcome in our trial was not "blind." It is, of course, almost impossible to ensure blind assessments in trials of nonpharmacologic treatment methods. In our trial, the assessments of progress used in the analyses were made by the patients and not by the therapists. Dr Deyo's comment that the observers in our trial were not blind is, therefore, irrelevant.Second, Dr Deyo says that our descriptions of the exercises and of