Early Physical Therapy vs Usual Care in Patients With Recent-Onset Low Back Pain

Abstract Objective The Fear-Avoidance Model of chronic pain (FAM) posits that pain catastrophizing and fear-avoidance beliefs are prognostic for disability and chronicity. In acute low-back pain, early physical therapy (PT) is effective in reducing disability in some patients. How early PT impacts short- and long-term changes in disability for patients with acute pain is unknown. Based on the FAM, we hypothesized that early reductions in pain catastrophizing and fear-avoidance beliefs would mediate early PT’s effect on changes in disability (primary outcome) and pain intensity (secondary outcome) over 3 months and 1 year. Subjects Participants were 204 patients with low-back pain of < 16 days duration, who enrolled in a clinical trial (NCT01726803) comparing early PT sessions or usual care provided over 4 weeks. Methods Patients completed the Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ work and physical activity scales) and outcomes (Oswestry Disability Index and Numeric Pain Rating Scale) at baseline, 4 weeks, 3 months, and 1 year. We applied longitudinal mediation analysis with single and multiple mediators. Results Early PT led to improvements in disability and pain over 3 months, but not 1 year. In the single mediator model, four-week reductions in pain catastrophizing mediated early PT’s effects on 3-month disability and pain intensity improvements, explaining 16% and 22% of the association, respectively, but the effects were small. Pain catastrophizing and fear-avoidance beliefs did not jointly mediate these associations. Conclusions In acute low-back pain, early PT may improve disability and pain outcomes at least partly through reducing patients’ catastrophizing.

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Re: Early Physical Therapy for Acute Low Back Pain May Not Reduce Health Services Utilization, Costs, and Opioid Use

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2019.03.003 ◽

2019 ◽

Vol 100 (7) ◽

pp. 1376-1377

Author(s):

Elizabeth Arnold ◽

Adam Goode ◽

Derek Clewley

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Health Services ◽

Health Services Utilization ◽

Low Back ◽

Opioid Use ◽

Services Utilization ◽

Acute Low Back Pain ◽

Early Physical Therapy

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A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2012/953139 ◽

2012 ◽

Vol 2012 ◽

pp. 1-61 ◽

Cited By ~ 116

Author(s):

Andrea D. Furlan ◽

Fatemeh Yazdi ◽

Alexander Tsertsvadze ◽

Anita Gross ◽

Maurits Van Tulder ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Usual Care ◽

Data Extraction ◽

Meta Analysis ◽

Sham Acupuncture ◽

Care Utilization ◽

Low Back ◽

Short Term

Background. Back pain is a common problem and a major cause of disability and health care utilization.Purpose. To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain.Data Sources. Records without language restriction from various databases up to February 2010.Data Extraction. The efficacy outcomes of interest were pain intensity and disability.Data Synthesis. Reports of 147 randomized trials and 5 nonrandomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically nonsignificant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature.Conclusions. CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments.

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