Physical therapy for low back pain may offer modest benefit
While there was a modest difference favoring early physical therapy at 3 months, a between-group difference did not achieve the threshold for minimum clinically important difference, and differences were mostly undetectable by 1 year.
Early physical therapy for recent-onset low back pain resulted in statistically significant improvement in disability compared to usual care, but the improvement was modest and did not achieve a clinically important difference considered at the individual patient level, according to a study.
Researchers randomly assigned 220 patients with recent-onset low back pain to early physical therapy (n=108; 4 physical therapy sessions of manipulation and exercise) or usual care (n=112; no additional interventions during the first 4 weeks). All participants received related education, and 207 patients (94.1%) completed 1-year follow-up.
Primary outcome was change in the Oswestry Disability Index (ODI) score (range, 0-100; higher scores indicate greater disability; minimum clinically important difference, 6 points) at 3 months. Secondary outcomes included changes in the ODI score at 4-week and 1-year follow-up and change in pain intensity, Pain Catastrophizing Scale (PCS) score, fear-avoidance beliefs, quality of life, patient-reported success, and health care utilization at 4-week, 3-month, and 1-year follow-up.
Results appeared in the Oct. 13 JAMA.
Early physical therapy showed improvement relative to usual care in disability after 3 months (between-group difference in ODI score, −3.2; 95% CI, −5.9 to −0.47; P=0.02). A significant difference was found between groups for the ODI score after 4 weeks (between-group difference, −3.5; 95% CI, −6.8 to −0.08; P=0.045]) but not at 1-year follow-up (between-group difference, −2.0; 95% CI, −5.0 to 1.0; P=0.19). There was no improvement in pain intensity at 4-week, 3-month, or 1-year follow-up (between-group difference, −0.42 [95% CI, −0.90 to 0.02], −0.38 [95% CI, −0.84 to 0.09], and −0.17 [95% CI, −0.62 to 0.27], respectively). The PCS scores improved at 4 weeks and 3 months but not at 1 year (between-group difference, −2.7 [95% CI, −4.6 to −0.85], −2.2 [95% CI, −3.9 to −0.49] and −0.92 [95% CI, −2.7 to 0.61], respectively). There were no differences in health care utilization at any point.
“We found that patients in both groups improved rapidly,” the authors wrote. “Rapid and substantial improvement by most patients with acute LBP [lower back pain] limits treatment effects in early intervention studies. We detected a modest difference favoring early physical therapy that was better than the natural history of acute LBP for the primary outcome at 3-month follow-up. However, the between-group difference did not achieve the threshold for minimum clinically important difference. Furthermore, differences were mostly undetectable by 1 year.”