2012년 10월 27일 토요일

Management patterns in acute low back pain: the role of physical therapy


Spine (Phila Pa 1976). 2012 Apr 20;37(9):775-82.


Title:
Management patterns in acute low back pain: the role of physical therapy


Authors
1. Gellhorn AC
2. Chan L
3. Martin B
4. Friedly J


Study Design
Retrospective cohort study


Objective

To evaluate the relationship between early physical therapy (PT) for acute low back pain and subsequent use of lumbosacral injections, lumbar surgery, and frequent physician office visits for low back pain.


Summary of Background Data

1. Wide practice variations exist in the treatment of acute low back pain.

2. PT has been advocated as an effective treatment although disagreement on its benefits.


Methods

1. Analyzed national 20% sample of the Centers for Medicare and Medicaid Services physician outpatient billing claims.

2. Patients received treatment for low back pain between 2003~2004 (n = 439,195).

3. To exclude chronic low back conditions,
* Excluded patients with a prior visit for back pain, lumbosacral injection, or lumbar surgery within the previous year.

4. Main outcome measures were rates of
* Lumbar surgery
* Lumbosacral injections
* Frequent physician office visits for low back pain during the following year


Results

[Adjusted odds ratio in Logistic regression analysis]

1) Lumber surgery in the group receiving PT in the acute phase (<4 weeks)
>>>  0.38 (95% confidence interval [CI], 0.360.41)
* Compared to patients receiving PT in the chronic phase (>3 months)
* Adjusting for age, sex, diagnosis, treating physician specialty, and comorbidity

2) Lumbosacral injection in the group receiving PT in the acute phase
>>>  0.46 (95% CI, 0.44-0.49)

3) Frequent physician office usage in the group receiving PT in the acute phase
>>>  0.47 (95% CI, 0.44-0.50)


Conclusion

1. There was a lower risk of subsequent medical service usage among patients who received PT early after an episode of acute low back pain relative to those who received PT at later times.

2. Medical specialty variations exist regarding early use of PT, with potential underutilization among generalist specialties.


Key points

1. Initial physician visit for low back pain within 30 day + PT

  >>> Decreased likelihood of receiving subsequent surgery or epidural steroid injections in the following year compared with those with PT after 90 days.
  
  >>> Lower frequent office visits than those with after 90 days


2. Wide variation exists between medical specialties regarding the use of PT


"This comes from Spine (c) 2012 Lippincott Williams & Wilkins, Inc."