After the intervention period, both experimental and control group participants received similar additional interventions deemed appropriate

by the treating physiotherapist with neither group receiving Strain-Counterstrain treatment. These included progression of home exercise program, ergonomic instruction, soft-tissue mobilisation, and joint mobilisation. The primary outcome was disability measured by the modified Oswestry low back pain disability questionnaire (Fritz and Irrgang, 2001). This measure has been shown to be valid and reliable (Fairbank et al 1980) and its properties have been studied rigorously (Beurskens et al 1996, Fritz and Irrgang, 2001, Davidson and Keating, 2002). The secondary outcomes included quality of life, pain, interference with work, satisfaction with symptoms, satisfaction with the intervention, a global rating of change, and the number of treatments post-intervention and adverse events. Quality check details Galunisertib cost of life was measured with the SF-36 questionnaire and calculated using all subscales (Ware and Sherbourne, 1992). This health-related quality of life questionnaire has been studied with low back pain populations and shown to have good validity, reliability, and responsiveness for most subscales (Taylor et al 2001) and has sufficient scale width to detect change in most people with low back pain (Davidson and Keating, 2002). Pain was rated by participants on a 10-cm visual analogue scale, which has been shown to be

valid and reliable (Price et al 1983, Duncan et al 1989, Price et al 1994). Each participant’s pain was summarised as the mean of three ratings on the visual analogue scale:

minimum pain in the last 24 hours, current pain, and maximum in the last 24 hours. The degree to which pain interfered with normal work, including both work outside the home and housework, was rated from 1 (not at all) to 5 (extremely). The degree to which the participant would be satisfied to spend the rest of their lives with their current symptoms was rated from 1 (very dissatisfied) to 5 (very satisfied). The participants’ satisfaction Thiamine-diphosphate kinase with their overall physiotherapy care during the period of intervention was also rated from 1 (very dissatisfied) to 5 (very satisfied). These outcomes have been recommended for low back pain research by an international group of researchers (Deyo et al 1998). Participants provided a ‘global-rating-of-change’ following the initial two-week intervention period, on a 7-point scale where response 1 = ‘completely gone’, 2 = ‘much better’, 3 = ‘better’, 4 = ‘a little better’, 5 = ‘about the same’, 6 = ‘a little worse’ and 7 = ‘much worse’ (Patrick et al 1995). A globalrating-of-change response of 3 or less was considered to represent improvement (Patrick et al 1995). The number of treatments received after the 2-week allocated intervention period, the number of adverse events, and the number of participants using medication for low back pain at Week 2 and Week 6 were recorded from patient records.