Utah: Early referral to physical therapy (exercise and manual therapy) for patients with acute low back pain and sciatica helped in improving disability and other outcomes compared with usual care (UC), suggests a recent study in the journal Annals of Internal Medicine.
Julie M. Fritz, College of Health, University of Utah, Salt Lake City, Utah, and colleagues evaluated whether early referral to physical therapy reduced disability more than UC alone for patients with acute sciatica. Fritz says she and her colleagues undertook this study because it's important for patients who seek care for their back pain to have evidence-based treatment options.
The randomized clinical trial included 220 adults (aged 18 to 60 years) with sciatica of less than 90 days' duration who were making an initial primary care consultation.
The participants underwent imaging and medication at the discretion of the primary care provider before enrollment. A total of 110 patients randomly assigned to UC were provided 1 session of education. 110 were randomly assigned to early physical therapy (EPT) and they were provided 1 education session and then referred for 4 weeks of physical therapy, including exercise and manual therapy.
The primary outcome was the change in patient-reported disability at 6 months as measured by Oswestry Disability Index (OSW).
Key findings of the study include:
Participants in the EPT group had greater improvement from baseline to 6 months for the primary outcome.
The OSW and several secondary outcomes favored EPT after 4 weeks.
After 1 year, between-group differences favored EPT for the OSW and back pain intensity.
The EPT group was more likely to self-report treatment success after 1 year (45.2%) than the UC group (27.6%) (relative risk, 1.6).
There were no significant differences in health care use or missed workdays.
"Results of our study demonstrated that referral from primary care to physical therapy for recent-onset sciatica improved disability and other outcomes compared with UC. The next critical step will be integrating the findings into clinical practice," concluded the authors.
The study, "Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica: A Randomized Controlled Trial," is published in the journal Annals of Internal Medicine.
DOI: https://www.acpjournals.org/doi/10.7326/M20-4187