Abstract: Early Physical Therapy vs Usual Care in Patients With Recent-Onset Low Back Pain
Randomized Clinical Trial Conclusions and Relevance:
Among adults with recent-onset LBP, early physical therapy resulted in statistically significant improvement in disability, but the improvement was modest and did not achieve the minimum clinically important difference compared with usual care.”
My Perspective:
As a practicing Orthopedic Manual Physical Therapist treating a high percentage of low back pain patients I believe this recent article published in JAMA 2015 is a beginning to assist us to best match patient diagnoses, medical history and specific patient needs toward a successful treatment outcome for patients suffering acute low back pain. That said, the recent NPR coverage title of it, “Physical Therapy May Help Low Back Pain, But Time is Best,” is very misleading.
The research they are quoting involves selected patients who have little predisposing factors to more complex low back disorders. Current research has found early physical therapy for certain populations of patients with certain subtypes of back pain can save significant healthcare dollars.[1]
As healthcare practitioners adjust to the rapid changes in healthcare system organization, reimbursement and research, physical therapists are active participants to find the “best way” to treat these acute low back pain populations in a cost effective manner. (2,3,4) The take away from all these articles is that moving toward a system of better predicting who needs what specific physical therapy interventions, at what stage, in what combination with other providers or services (counseling, pain management education, etc) is the direction we need to and are heading. Physical therapy is a leader in conducting this research to find that best evaluation and treatment management system in US healthcare.
Your thoughts?
–Karen Walz, PT, DPT, OCS, COMT, FAAOMPT
NAIOMT Clinical Fellowship Instructor/Faculty and Examiner
The North American Institute for Orthopaedic Manual Therapy
NAIOMT is a leader in the manual physical therapy continuing education field in promoting the use of eclectic, clinically reasoned, evidence based evaluation and treatment techniques for the low back. Browse upcoming courses including Lumbopelvic Spine here.
1. Fritz, Julie M. PhD, PT, ATC*†; Cleland, Joshua A. PhD, DPT, FAAOMPT‡; Speckman, Matthew§; Brennan, Gerard P. PhD, PT*; Hunter, Stephen J. MS, PT, OCS*. Physical Therapy for Acute Low Back Pain: Associations With Subsequent Healthcare Costs. Spine:15 July 2008 – Volume 33 – Issue 16 – pp 1800-1805
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Fritz JM1, Kim J2, Thackeray A3, Dorius J4.Phys Ther.Physical Therapy Utilization in Medicaid Enrollees With Low Back Pain.2015 Aug 27. [Epub ahead of print]
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Beneciuk JM, Bishop MD, Fritz JM, et al. The STarT back screening tool and individual psychological measures: evaluation of prognostic capabilities for low back pain clinical outcomes in outpatient physical therapy settings. Phys Ther 2013;93:321-33.
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Hidalgo B. Evidence based orthopaedic manual therapy for patients with nonspecific low back pain: An integrative approach. J Back Musculoskelet Rehabil.2015 Sep 6. [Epub ahead of print]
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