Early physiotherapy for selected patients with acute low back pain leads to small improvements in disability compared with usual care based on advice [commentary]

摘要

Summary of: Fritz JM, Magel JS, McFadden M, Asche C, Thackeray A, Meier W, Brennan G. Early physical therapy vs usual care in patients with recent-onset low back pain. JAMA 2015;314(14)[4_TD$FDIF:] 1459-1467. [1_TD$FDIFQ] uestion: Does early physiotherapy $T[_5DDIFrF] educe disability in selected patients with acute low back pain? Design: Randomised, controlled trial with concealed allocation and blinded outcome assessment. Setting: A primary care centre in the United States. Participants: Key inclusion criteria were: adults with low back pain of less than 16 days duration, an Oswestry score > 20% and symptoms not extending below the knee. KF_$TIDD[F6] ey exclusion criteria were previous lumbar surgery or signs of nerve root compression2$_T[DDIF.F] Randomisation of 220 participants allocated 108 to the early physiotherapy group and 112 to a usual care group. Interventions: Both groups received education about the favourable prognosis of low back pain and were advised to stay as active as possible, and to follow-up with the primary care physician as needed. In addition, the early physiother- apy group received four treatment sessions over 3 weeks with a physiotherapist. Physiotherapy comprised a high velocity spinal manipulation technique, and instruction on range of motion and trunk strengthening exercises, which patients were advised to perform 10 times three to four times each day. Outcome measures: The primary outcome was the change in the Oswestry Disability Index (scored [I7$_DTDF]Ffrom 0 to 100, with higher scores indicating greater disability) at 3 months. Secondary outcome measures, measured at 4 weeks, 3 months and 1 year, included a numeric pain rating of low1836-9553/ 2016 Australian Physiotherapy Association. Published by Elsevier B creativecommons.org/licenses/by-nc-nd/4.0/).back pain severity, pain catastrophising scale, fear avoidance beliefs questionnaire, global rating of change, and the EuroQol tool. Results: A total of 214 participants completed the 3-month follow-up. At 3 months, the Oswestry Disability Index improved more in the early physiotherapy group than the usual care group, by C3.2 units (95% confidence interval C5.9 to C[8D_DT$IFF]0.5). At 1 year, the Oswestry Disability Index scores did not significantly differ between groups (mean difference C2.0 units, 95% CI C5.0 to 1.0). At 3 months,[_9TDDF$IF] some secondary outcomes, such as the pain catastrophising scale, fear avoidance beliefs for work, and patient self-rating of success and overall health, improved significantly more in the early physiother- apy group when compared to usual 0[T1_DD$IFF]care. At 12 months, there were no differences between the groups, except for patient rating of overall health and quality of life, which favoured the early physiotherapy group. Conclusion: The addition of early physiother- apy, which focused on spinal manipulation and exercise prescription in selected patients, led to small improvements in disability and quality of life compared to usual care alone. Provenance: Invited. Not peer1[1D_DT$IFF] reviewed. Nicholas Taylor Section Editor, Journal of Physiotherapy http://dx.doi.org/10.1016/j.jphys.2016.05.001.