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Physiotherapist and Research Scholar, ESIC Model Hospital & PG Research Institute- ESICPGIMSR (Under Govt of India),Rajaji Nagar, Bangalore and General Secretary of Bangalore Physiotherapist Network (BPN) 2017-2020

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17 Nov 2015

Customized Physical therapy may provide more relief for lower back pain than general advice on the best ways to remain active, an Australian study published in British Journal of Sports Medicine suggests.

Customized Physical therapy may provide more relief for lower back pain than general advice on the best ways to remain active, an Australian study published in British Journal of Sports Medicine suggests.

Researchers offered 300 patients with lower back pain two advice sessions explaining the source of their discomfort and providing instruction on proper lifting techniques. Roughly half of them also got 10 treatment sessions of personalized physical therapy over 10 weeks.

The physical therapy group had significantly greater reductions in activity limitations at 10, 26 and 52 weeks than the advice group and they also had less back pain at 5, 10 and 26 weeks.

“Our findings suggest that advice works for many people but that individualized physical therapy achieves more rapid reduction in pain and in the long term superior improvements in function/disability,” lead study author Jon Ford of La Trobe University in Bundoora, Australia said by email.

Low-back disorders are one of the most common afflictions that bring people to the doctor, and many of these patients with acute problems have persistent symptoms for at least a year, Ford and colleagues note in the British Journal of Sports Medicine.

To be included in the study, patients needed to have experienced pain for six weeks to six months and have one of five specific types of back pain: disc herniation, reducible disc pain, non-reducible disc pain, joint pain or multifactorial persistent pain.

Patients assigned to customized physical therapy in the study using specific exercise techniques tailored to the type of injury and individual barriers to recovery. Some, for example, focused on posture and lifting to ease disc pain, while others with disc herniation worked on motor control targeting specific muscle groups.

Participants in both the advice and the physical therapy groups improved over time, but the people who received the customized exercise sessions generally did better.

One shortcoming of the study is that the advice group had far fewer encounters with health providers than the physical therapy group, the authors acknowledge.

“There was an 8-session difference in treatment groups, so there was a notable difference in provider attention that could account for some of these group differences,” Steven George, a physical therapy researcher at the University of Florida who wasn’t involved in the study, said by email.

In addition, the differences in outcomes between the two groups aren’t that large, as is often the case in studies of back pain, noted Julie Fritz, associate dean for research at the College of Health at the University of Utah in Salt Lake City.

“Back pain is very common and many patients are advised to attend physical therapy at some point,” Fritz said by email. “The challenge for researchers is to continue to examine which particular physical therapy interventions work for specific types of patients with low back pain and determine the optimal timing for physical therapy intervention.”

Abstract

Background: Many patients with low-back disorders persisting beyond 6 weeks do not recover. This study investigates whether individualised physiotherapy plus guideline-based advice results in superior outcomes to advice alone in participants with low-back disorders.

Methods: This prospective parallel group multicentre randomised controlled trial was set in 16 primary care physiotherapy practices in Melbourne, Australia. Random assignment resulted in 156 participants receiving 10 sessions of physiotherapy that was individualised based on pathoanatomical, psychosocial and neurophysiological barriers to recovery combined with guideline-based advice, and 144 participants receiving 2 sessions of physiotherapist-delivered advice alone. Primary outcomes were activity limitation (Oswestry Disability Index) and numerical rating scales for back and leg pain at 5, 10, 26 and 52 weeks postbaseline. Analyses were by intention-to-treat using linear mixed models.

Results: Between-group differences showed significant effects favouring individualised physiotherapy for back and leg pain at 10 weeks (back: 1.3, 95% CI 0.8 to 1.8; leg: 1.1, 95% CI 0.5 to 1.7) and 26 weeks (back: 0.9, 95% CI 0.4 to 1.4; leg: 1.0, 95% CI 0.4 to 1.6). Oswestry favoured individualised physiotherapy at 10 weeks (4.7; 95% CI 2.0 to 7.5), 26 weeks (5.4; 95% CI 2.6 to 8.2) and 52 weeks (4.3; 95% CI 1.4 to 7.1). Responder analysis at 52 weeks showed participants receiving individualised physiotherapy were more likely to improve by a clinically important amount of 50% from baseline for Oswestry (relative risk (RR=1.3) 1.5; 95% CI 1.2 to 1.8) and back pain (RR 1.3; 95% CI 1.2 to 1.8) than participants receiving advice alone.

Conclusions: 10 sessions of individualised physiotherapy was more effective than 2 sessions of advice alone in participants with low-back disorders of ≥6 weeks and ≤6 months duration. Between-group changes were sustained at 12 months for activity limitation and 6 months for back and leg pain and were likely to be clinically significant.


Journal Source: http://bjsm.bmj.com/content/early/2015/10/20/bjsports-2015-095058.short?rss=1ly/1PoQKkC
British Journal of Sports Medicine, online October 20, 2015.


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