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Low-back pain is the leading cause of disability world-wide. In 2009, the direct costs of low back pain to the NHS were estimated at £2.8 billion[1] (this figure excludes the economic burden of low back pain, such as time off work and lost productivity).

Back Skills Training (BeST) is a proven, robust and cost-effective intervention for treating low back pain which uses cognitive behavioural strategies to improve physical activity and function, and reduce pain.

Yet, to get BeST into common use across the NHS would take a huge amount of time, effort and money using traditional face-to-face workshops to train healthcare professionals.

[1] Hong J, Reed C, Novick D, Happich M. Costs associated with treatment of chronic low back pain: an analysis of the UK General Practice Research Database. Spine. 2013 Jan 1;38(1):75-82.

The CLAHRC and its partners have repackaged the essentials of the original BeST course into an easily accessible online e-learning system, called iBeST.

This will allow more clinicians to be trained more quickly in how to deliver BeST to their patients with low back pain. Rapidly bringing this treatment to patients across the NHS to improve their quality of life and reduce their low back pain.

iBeST consists of a number of modules including explanatory videos and downloadable information and patient packs.

Delivering the BeST training online has three main advantages:

  1. Costs are far lower.
  2. Training is much more accessible across the NHS.
  3. Uptake of this approach across the NHS could be far more rapid.

All of which work together to bring the benefits of BeST to more patients sooner.

BeST has already been shown to be the most cost-effective treatment for low back pain[1] offering patients significantly reduced disability and pain at 12 months with sustained long-term (>36 months) benefit compared to usual treatment.[2] This has resulted in BeST being recommended in NICE back pain guidelines[3].

As of April 2018, the 1270 NHS therapists have enrolled in the iBeST online training programme, 744 therapists have started training and 462 have completed the training. 36 NHS hospitals have been collecting data to evaluate the programme, bringing benefits to 628 patients across the country. 

iBeST is poised to positively impact patient outcomes at a national scale, as well as reducing the societal and NHS costs of low back pain.

The lessons learnt from developing iBeST are already being used to inform the development of similar online e-learning platforms for other interventions, offering similar cost and access benefits.

[1] Lamb SE, et al (2010) Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis. THE LANCET, 375 (9718), 916–923

[2] Lamb, S.E. et al., 2012. Group cognitive behavioural interventions for low back pain in primary care: Extended follow-up of the Back Skills Training Trial. (ISRCTN54717854). PAIN, 153(2), 494–501


The BeST intervention has already been incorporated into NICE guidelines.

We anticipate with the publication of another definitive study based on the CLAHRC’s iBeST work, the demand for BeST will continue to strengthen, encouraging NHS therapy services to adopt BeST at the expense of costlier and less effective alternatives, saving commissioners and the NHS a substantial amount of money.

This training will continue to be provided free of cost to NHS practitioners, supported by a business model of providing iBeST at a cost to people working outside of the NHS (e.g. private physiotherapists or healthcare services in other countries), which may allow iBeST to become self-sustaining in the future.