Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica

Fritz, Julie M.; Lane, Elizabeth; McFadden, Molly; Brennan, Gerard; Magel, John; Thackeray, Anne; Minick, Kate I.; Meier, Whitney; Greene, Tom

doi:10.7326/m20-4187

Cited by 24 publications

(57 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study expands on an earlier study revealing a low proportion of individuals with LBP initially contacting a PCP have timely incorporation of guideline-adherent non-pharmacologic and non-interventional therapies 17 . This study corroborates previous studies that found earlier use of first-line therapies may be associated with a reduction in use of low value services and prescription pharmaceuticals, including opioids 30,31,45 . The study finding that the benefits of early use of first-line therapies are most evident if initiated within 7 days of initially contacting a PCP corroborates a similar finding 28 , has potentially important translation implications, and warrants additional study.…”

Section: Discussionsupporting

confidence: 91%

“…Previous studies exploring the association between PCP referral of individuals with LBP for first-line therapies have examined referral for “chiropractic” or “physical therapy” 25,30,31,46 , terms that conflate HCP type and types of health care services that may or may not be provided. This study expands on this earlier work in two ways.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Low back pain service utilization and costs: association with timing of first-line services for individuals initially contacting a primary care provider. A retrospective cohort study

Elton

Zhang

2022

Preprint

View full text Add to dashboard Cite

Background: Low back pain (LBP) is prevalent, costly, and a common reason for a visit to a primary care provider (PCP). Guidelines recommend a stepped approach to management. Objective: For individuals with LBP initially contacting a PCP, examine the association between the incorporation of first-line therapies, use of second- and third-line services and total episode cost. Design: Retrospective cohort study Setting/Patients: National sample of individuals with non-surgical LBP occurring in 2017-2019. Measurements: Independent variables were initial contact with a PCP, and the timing of incorporation of 5 types of first-line therapies. Dependent measures included use of 14 types of health care services and total episode cost. Results: 8.5% of 118,503 PCPs initially contacted by 308,790 individuals with 347,627 episodes of non-surgical LBP were associated with an episode including any first-line service at any time. 17.5% of episodes included any first-line service at any time. Active care (11.6% of episodes), manual therapy (8.0%) and chiropractic manipulative therapy (7.0%) were the most common first line services. 5.4% of episodes included a first-line service during the first 7 days. These episodes were associated with a modest reduction in the use of prescription pharmaceuticals, with no impact on the use of imaging or spinal injection. First-line services were associated with an increase in total episode cost with the smallest increase associated with chiropractic and osteopathic manipulation. Younger individuals from ZIP codes with higher adjusted gross income were more likely to receive a first-line service in the first 7 days of an episode. Limitations: As a retrospective observational analysis of associations there are numerous potential confounders and limitations. Conclusions: Individuals with non-surgical LBP initially contacting a PCP infrequently receive a first-line service, and if received, it is typically in addition to second- and third-line pharmaceutical, imaging, and interventional services. There is an opportunity to improve concordance with the stepped approach to management described in LBP guidelines.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Low back pain service utilization and costs: association with timing of first-line services for individuals initially contacting a primary care provider. A retrospective cohort study

Elton

Zhang

2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Recently published randomized trials using usual medical care comparators support this assertion. One trial reported that patients undergoing physical therapy had a small improvement in function and pain compared to usual medical care for sciatica, 58 while another trial indicated adding chiropractic care to usual medical care for back pain improved 6-week function and pain ratings. 59 Since usual medical care often includes non-pharmacologic options these trials cannot be interpreted as direct comparisons to pharmacologic, intervention, or surgical approaches.…”

Section: Belief Practice and Culturementioning

confidence: 99%

Back and neck pain: in support of routine delivery of non-pharmacologic treatments as a way to improve individual and population health

George

Lentz

Goertz

2021

Translational Research

View full text Add to dashboard Cite

show abstract

“…Clinical practice guidelines and systematic reviews recommend several conservative treatments as the initial treatment for patients with sciatica [11][12][13]. Referring acute sciatica patients to physical therapy improve clinical outcomes [14]. Conservative treatment strategies aim to reduce pain intensity and maintain function.…”

Section: Introductionmentioning

confidence: 99%

Neural management plus advice to stay active on clinical measures and sciatic neurodynamic for patients with chronic sciatica: Study protocol for a controlled randomised clinical trial

et al. 2022

View full text Add to dashboard Cite

Advice to stay active is the primary management strategy for sciatica. Other conservative treatments such as neural management techniques may also contribute to sciatica recovery, but currently, the effects have not been robustly assessed. Thus, the aim of this study is to compare the effects of adding neural management to advice to stay active versus advice to stay active alone in improving pain intensity and functional limitation. Secondarily, to compare the effects of the experimental intervention in the sciatic neurodynamic, pain modulation, and psychosocial factors. A parallel-group, controlled, examiner-blinded superiority clinical trial randomised at a 1:1 allocation will be conducted in 210 participants with chronic sciatica. Patients will be recruited from outpatient physiotherapy clinics and community advertisements. The experimental group will receive neural mobilisation techniques and soft tissue mobilisation techniques for 30 minutes per session, 10 weekly sessions, plus advice to stay active on their activities of daily living, information on physical activity, imaging tests, and sciatica for 5 biweekly sessions lasting 25–30 minutes. The control group will receive advice to stay active only. The re-evaluation will be performed out after 5 weeks, 10 weeks, and 26 weeks after randomisation and primary endpoints will be pain intensity and functional limitation at 10 weeks. Secondary outcomes will include neuropathic symptoms, sciatic neurodynamic, pain modulation, and psychosocial factors. Adverse events and patient satisfaction will be assessed. Ethical approval has been granted from an Institutional Human Research Ethics Committee. Trial registration: Trial was prospectively registered in the Brazilian Registry of Clinical Trials (number: RBR-3db643c).

show abstract

Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica

Cited by 24 publications

References 42 publications

Low back pain service utilization and costs: association with timing of first-line services for individuals initially contacting a primary care provider. A retrospective cohort study

Low back pain service utilization and costs: association with timing of first-line services for individuals initially contacting a primary care provider. A retrospective cohort study

Back and neck pain: in support of routine delivery of non-pharmacologic treatments as a way to improve individual and population health

Neural management plus advice to stay active on clinical measures and sciatic neurodynamic for patients with chronic sciatica: Study protocol for a controlled randomised clinical trial

Contact Info

Product

Resources

About