Early Physical Therapy for Acute Low Back Pain May Not Reduce Health Services Utilization, Costs, and Opioid Use
We read with interest the article published by Arnold et al1 examining the effect of timing of physical therapy (PT) for acute low back pain on health services utilization (HSU). Reducing overuse of imaging, opioids, injections, and surgery for low back pain is an international priority.2 That early access to PT could replace or reduce many of these ser vices is not an unreasonable proposition, and one that is worthy of rigorous scientific investigation. However, we feel that by emphasizing observational studies over randomized controlled trials in their synthesis of available literature, the authors have, in this case, taken an approach that was s uboptimal.
Discussion: The current case series describes the use of a targeted exercise approach consisting mostly of hip abductor strengthening in a group of patients with CLBP and hip abductor weakness. The results indicated that this approach may be effective in reducing pain and improving function, particularly for older patients.
We would like to thank the authors of the Letter to the Editor for their interest and insight into our review, “The Impact of Timing of Physical Therapy for Acute Low Back Pain on Health Services Utilization.”1 We agree that to make more definitive causal claims about the outcomes from the timing of physical therapy, randomized control trials (RCTs) are needed. The final version of the abstract will refl ect a modification that removes causal claims. We believe that future research in this area should focus on using rigorous methodological designs that include randomization and observational studies that use la...
Conclusions Wearing lumbosacral orthosis for an average of 7.21 hrs/d for 4 wks in conjunction with routine physical therapy did not affect the thickness of obliquus internus, transversus abdominis, and lumbar multifidus.
This study investigated the influence of isostretching on patients with chronic low back pain. Methods: It was a randomized, controlled trial with concealed allocation, intention-to-treat analysis, and blind assessment. Fifty-four patients with chronic low back pain were randomized to an experimental group and a control group. The experimental group performed isostretching twice a week for 45 days, while the control group remained on the waiting list for physical therapy. Patients were submitted to evaluations at baseline, after 20 and 45 days of treatment with regard to pain, quality of life, functional capacity, and sati...
Low back pain is the leading cause of global disability24,9,45 and urgently requires better management.9 80% of the adult population experiences a significant episode of disabling low back pain over their life. Most people recover, however 10-15% go on to develop chronic low back pain (CLBP), defined as pain lasting over 12 weeks.12 90% of people with CLBP have a non-specific problem with no clearly identifiable cause for their pain.17 CLBP is increasing in prevalence and is globally the second most frequent reason for time off work.
Journal of Orthopaedic&Sports Physical Therapy,Volume 49, Issue 6, Page 367-369, June 2019.
Journal of Orthopaedic&Sports Physical Therapy,Volume 49, Issue 6, Page 370-379, June 2019.
Journal of Orthopaedic&Sports Physical Therapy,Volume 49, Issue 6, Page 380-388, June 2019.
Journal of Orthopaedic&Sports Physical Therapy,Volume 49, Issue 6, Page 389-401, June 2019.
Journal of Orthopaedic&Sports Physical Therapy,Volume 49, Issue 6, Page 402-414, June 2019.