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.
