Edinburgh Napier University

  This paper provides physiotherapists with a manual to set up and run the Back to Fitness programme that was recently evaluated in a trial published in the British Medical Journal ( Klaber Moffett et al, 1999 ). The promising findings have attracted interest nationally and internationally. Reactivation of back pain patients is widely accepted as important for those who are not recovering at about four to six weeks and this is endorsed by clinical guidelines. Different approaches may be effective. However, some evidence is now available which demonstrates that a simple Back to Fitness programme delivered by physiotherapists with some additional understanding of cognitive-behavioural principles can be both clinically effective and cost-effective. The programme consists of eight one-hour sessions carried out usually in the early evening over a four-week period, and includes a simple message of educational advice consistent with The Back Book. This is referred to as ‘Tip for the Day'.

One of the main aims is to help participants overcome their fear of movement and pain, thus helping them to return to normal activities. This manual, which has not been published elsewhere, should enable physiotherapists to set up the programme. We would urge interested physiotherapists to familiarise themselves with the relevant literature provided in the reference list before setting up the classes. We also recommend that close liaison or ‘coaching' from a clinical psychologist working in the field of pain would be helpful, particularly if patients with chronic disabilities and inappropriate pain behaviour are to be included.

The programme has been tested mainly on mild to moderately disabled patients and may not be appropriate for more intractable conditions where a more intensive multidisciplinary pain programme might be appropriate.