Early Physical Therapy vs Usual Care for Low Back Pain-Related Disability

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Usual care consisted of a 20-minute educational session on self-management strategies.
Usual care consisted of a 20-minute educational session on self-management strategies.

Early physical therapy was not found to be superior to usual care for improving disability at 1 year in patients with low back pain, in a randomized trial published in Spine.

Investigators recruited a total of 119 military service members with low back pain who were seeking or receiving care from a general practitioner. Patients were randomly assigned to receive usual care (n=61) or early physical therapy (n=58).

Usual care consisted of a 20-minute educational session on self-management strategies. In addition, patients had the option of receiving a written modification of required activity for up to 1 month and up to 10-days' prescription of nonsteroidal anti-inflammatory drugs.

Study participants in the early physical therapy group received usual care and started physical therapy within 72 hours for a total of 8 sessions. The investigators assessed disability outcomes with the Oswestry index at baseline, at 4 weeks, at 3 months, and at 1 year.

Improvements in disability were comparable in the 2 groups at 1 year but were greater in patients receiving early physical therapy at 4 weeks (mean difference, 4.4; 95% CI, 0.41-10.1; P =.042). Mean healthcare costs at 1 year were not improved by usual care or early physical therapy (usual care: $5037; 95% CI, $4171-$6082 vs physical therapy: $5299; 95% CI, $4367-$6431; P =.712).

Usual care resulted in lower mean lumbar-related healthcare spending at 1 year compared with early physical therapy (usual care: $1096.37; 95% CI, $855.27-$1405.43 vs physical therapy: $2016.31; 95% CI, $1569.56-$2590.22; P =.001).

Because this study was carried out in a small sample of patients from the military, the findings may not be applicable to patients with low back pain in other populations.

“To better understand the impact of timing of care in this single-payer military health system, further research is needed to identify optimal outcome measures, the influence of interventions on general health, and optimal methods to deliver effective care in this challenging setting,” concluded the study authors.

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Reference

Rhon D, Miller R, Fritz J. Effectiveness and downstream healthcare utilization for patients that received early physical therapy versus usual care for low back pain: a randomized clinical trial [published online February 27, 2018]. Spine (Phila Pa 1976). doi: 10.1097/BRS.0000000000002619

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