Providing services for acute low-back pain: A survey of Australian physiotherapists

Keating, Jennifer Lyn; McKenzie, Joanne E.; O’Connor, Denise; French, Simon; Walker, Bruce F.; Charity, Melanie; Page, Matthew J.; Green, Sally

doi:10.1016/j.math.2015.11.005

Cited by 16 publications

(18 citation statements)

References 26 publications

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“…After removing duplicates and screening 8567 titles and abstracts and 254 full-texts reports, 94 studies were included (figure 1). Physical therapy treatment choices were investigated for low back pain (n=48 studies),11–58 knee pain (n=10),32 34 57 59–65 neck pain or whiplash (n=11),15 18 32 34 51 66–71 foot or ankle pain (n=5),72–76 shoulder pain (n=7),15 51 77–81 pre or post knee arthroplasty (n=6)46 82–86 (including one study of hip and knee arthroplasty86) and other musculoskeletal or orthopaedic conditions (where treatment choices were only reported in one study or where one of either recommended or not recommended treatments could not be inferred from guidelines or systematic reviews) (n=18) 87–104. We contacted 15 authors for data (regarding 18 studies): 12 responded and 5 were able to provide the data we requested (regarding six studies) 15 16 22 64 89 100.…”

Section: Resultsmentioning

confidence: 99%

Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? Systematic review

2019

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ObjectivesPhysicians often refer patients with musculoskeletal conditions to physical therapy. However, it is unclear to what extent physical therapists’ treatment choices align with the evidence. The aim of this systematic review was to determine what percentage of physical therapy treatment choices for musculoskeletal conditions agree with management recommendations in evidence-based guidelines and systematic reviews.DesignSystematic review.SettingWe performed searches in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine, Scopus and Web of Science combining terms synonymous with ‘practice patterns’ and ‘physical therapy’ from the earliest record to April 2018.ParticipantsStudies that quantified physical therapy treatment choices for musculoskeletal conditions through surveys of physical therapists, audits of clinical notes and other methods (eg, audits of billing codes, clinical observation) were eligible for inclusion.Primary and secondary outcomesUsing medians and IQRs, we summarised the percentage of physical therapists who chose treatments that were recommended, not recommended and had no recommendation, and summarised the percentage of physical therapy treatments provided for various musculoskeletal conditions within the categories of recommended, not recommended and no recommendation. Results were stratified by condition and how treatment choices were assessed (surveys of physical therapists vs audits of clinical notes).ResultsWe included 94 studies. For musculoskeletal conditions, the median percentage of physical therapists who chose recommended treatments was 54% (n=23 studies; surveys completed by physical therapists) and the median percentage of patients that received recommended physical therapy-delivered treatments was 63% (n=8 studies; audits of clinical notes). For treatments not recommended, these percentages were 43% (n=37; surveys) and 27% (n=20; audits). For treatments with no recommendation, these percentages were 81% (n=37; surveys) and 45% (n=31; audits).ConclusionsMany physical therapists seem not to follow evidence-based guidelines when managing musculoskeletal conditions. There is considerable scope to increase use of recommended treatments and reduce use of treatments that are not recommended.PROSPERO registration numberCRD42018094979.

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Section: Resultsmentioning

confidence: 99%

Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? Systematic review

2019

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“… Not defined in PICO of SR. See above [ 53 , 63 , 64 , 67 – 70 ]. Manipulation or educational booklet [ 11 ] .Manual therapy or General practice [ 60 ] .Advice with usual care [ 72 ]. Pain, global measure, back pain-specific functional status, return to work, ROM, generic functional status, medication use and side effects.…”

Section: Resultsmentioning

confidence: 99%

“…Many patients with acute LBP are managed in primary care settings and may visit a physiotherapist [ 3 ]. Physiotherapists offer many interventions for this patient group, of which one of the most widely used is exercise therapy [ 9 – 11 ]. This practice is concordant with clinical guidelines for the management of low back pain in primary care [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…This seems to be the case not only concerning physiotherapeutic interventions but for pharmacological treatment as well [ 25 ]. Exercise therapy, frequently used in clinical physiotherapy practice [ 9 – 11 ], is no exception from this uncertainty of clinically relevant effect [ 7 , 17 , 26 , 27 ]. Many systematic reviews conclude that exercise therapy is effective for patient with acute LBP, but that the evidence is inconclusive [ 20 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

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Effects of exercise therapy in patients with acute low back pain: a systematic review of systematic reviews

et al. 2020

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Background Acute low back pain is associated with pain and disability, but symptoms are often self-healing. The effectiveness of exercise therapy for acute low back pain remains uncertain with conflicting evidence from systematic reviews. The aim of this systematic review of systematic reviews was to assess the overall certainty of evidence for the effects of exercise therapy, compared with other interventions, on pain, disability, recurrence, and adverse effects in adult patients with acute low back pain. Methods PubMed, the Cochrane library, CINAHL, PEDro, Open Grey, Web of Science, and PROSPERO were searched for systematic reviews of randomized controlled trials. Methodological quality was assessed independently by two authors using AMSTAR. Meta-analyses were performed if possible, using data from the original studies. Data for pain, disability, recurrence, and adverse effects were analyzed. Certainty of evidence was assessed using GRADE. Results The searches retrieved 2602 records, of which 134 publications were selected for full-text screening. Twenty-four reviews were included, in which 21 randomized controlled trials (n = 2685) presented data for an acute population, related to 69 comparisons. Overlap was high, 76%, with a corrected covered area of 0.14. Methodological quality varied from low to high. Exercise therapy was categorized into general exercise therapy, stabilization exercise, and McKenzie therapy. No important difference in pain or disability was evident when exercise therapy was compared with sham ultrasound, nor for the comparators usual care, spinal manipulative therapy, advice to stay active, and educational booklet. Neither McKenzie therapy nor stabilization exercise yielded any important difference in effects compared with other types of exercise therapy. Certainty of evidence varied from very low to moderate. Conclusions The findings suggest very low to moderate certainty of evidence that exercise therapy may result in little or no important difference in pain or disability, compared with other interventions, in adult patients with acute low back pain. A limitation of this systematic review is that some included reviews were of low quality. When implementing findings of this systematic review in clinical practice, patients’ preferences and the clinician’s expertise also should be considered, to determine if and when exercise therapy should be the intervention of choice. Systematic review registration PROSPERO: CRD46146, available at: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=46146.

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“…The reasons for radiology imaging in the present study are unknown. Perhaps patients with on-going WAD continue to search for a diagnosis to legitimise their pain, and may request or demand additional testing [33,34]. Clinicians may not be adequately prepared to explain reasons why imaging may be inappropriate and possibly detrimental [35], or may fear missing a fracture [32].…”

Section: Discussionmentioning

confidence: 99%

Medical and allied health service use during acute and chronic post-injury periods in whiplash injured individuals

Ritchie

Smith

Sterling

2020

BMC Health Serv Res

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Background: Individuals with whiplash associated disorder (WAD) frequently experience neck pain in addition to other physical, psychological and social symptoms. Consequently, treatment is sought from a variety of health professionals. The limited data available about health services use in this population are conflicting. This study aimed to characterise health service use in individuals with WAD from a motor vehicle crash. Methods: Medical (general practitioner (GP), medical specialist, emergency services (ED), radiologyx-ray, computed tomography, magnetic resonance imaging, ultrasound) and allied health service (physiotherapy, chiropractor, psychologist, osteopath, occupational therapy) use during acute (< 12 weeks) and chronic (12 weeks to 2 years) post-injury periods were analysed in adults claiming compensation for WAD in the no-fault jurisdiction of Victoria, Australia (n = 37,315). Results: Most WAD claimants had an acute post-injury health service payment (95%, n = 35,348), and approximately onethird (29%, n = 10,871) had a chronic post-injury health service payment. During an acute post-injury period, the most frequently compensated services were for: ED (82% of acute claimants), radiology (56%), and medical specialist (38%). Whereas, physiotherapy (64.4% of chronic claimants), GP (48.1%), and radiology (34.6%) were the most frequently paid services during the chronic period. Females received significantly more payments from physiotherapists (F = 23.

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Providing services for acute low-back pain: A survey of Australian physiotherapists

Cited by 16 publications

References 26 publications

Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? Systematic review

Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? Systematic review

Effects of exercise therapy in patients with acute low back pain: a systematic review of systematic reviews

Medical and allied health service use during acute and chronic post-injury periods in whiplash injured individuals

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