The role of early physical therapy in low back pain management
Disagreement on PT's effectiveness leads to conflicting recommendations
It's well understood that low back pain (LBP) is an extremely prevalent health condition throughout the world, with lifetime prevalence in adults between 65-80%, and that the condition is therefore a major matter of concern that requires optimal treatment methods. Despite its massive occurrence rates, wide variations exist in diagnosing and treating acute LBP episodes, and a number of experts have contrasting views. Many have long supported physical therapy (PT) as an effective treatment, but some claim its benefits are unproven and that evidence is mixed, which has led to international guidelines with conflicting recommendations for manipulation and exercise therapy. To better evaluate these dynamics, a study compared early PT for acute LBP to other treatments with the intention of determining which is most effective and at what stage of the condition.
Immense number of study participants assists in providing reliable data
Participants were sought out and selected if physicians reported a primary diagnosis of LBP, and the search process turned out an impressive 431,195 eligible subjects who were used for further analysis. These patients were subsequently categorized into seven more specific groups: nonspecific backache (63.6% of patients), sciatica/radiculitis (14.5%), degenerative disc disease (10.5%), spinal stenosis (6.2%), herniated disc, possible instability, and miscellaneous causes, each of which accounted for less than 3%. The primary variable of interest was time between an initial visit for LBP and an outpatient PT visit, and the phases of LBP were categorized as acute (1-30 days after initial physician encounter), subacute (31-90 days) and chronic (91-365 days). Additional information regarding episodes of surgery, lumbosacral injections and back-related physician office visits after the initial visit was also recorded.
Early PT shown to decrease likelihood of additional interventions
Within one year from the initial physician encounter for LBP, 16.2% of participants received PT, 11.9% received lumbosacral injections and 3.1% underwent lumbar surgery. Among all patients who received PT, the mean time to initiation of PT was 86 days, with a range of 1-365 days, with 52% receiving PT in the acute stage, 18.1% in the subacute stage and 29.9% in the chronic stage. Overall, data showed a strong association between the utilization of early PT and a decrease in the likelihood of subsequent lumbar surgery, lumbosacral injection and frequent LBP-related physician visits in the year following initial evaluation when compared to PT at later stages. This may be due to several benefits of PT, including the increase of patients' overall activity level and the continued education they receive in treatment. The incredible sample size and design of this study should serve as further evidence and support for the use of early PT in treating LBP, and physicians in the generalist specialties should take heed to this information and consider utilizing early PT interventions more often for LBP.
-Summarized by Greg Gargiulo
-As reported in the Nov. '10 edition of Spine
