Physical Therapy Has Modest Effects on Acute Low Back Pain Save

A new JAMA study shows new onset back pain treated with physical therapy yields modest short-term (3 months) improvement. 

Although early physical therapy for recent-onset low back pain resulted in statistically significant improvement in disability compared to usual care, the improvement was modest and did not achieve a difference considered clinically important at the individual patient level, according to a study in the October 13 issue of JAMA.

Lifetime prevalence of low back pain (LBP) is about 70 percent and accounts for 2 percent to 5 percent of all physician visits. The effect of early physical therapy for LBP is unclear. Guidelines advise delaying referral to physical therapy or other specialists for a few weeks to permit spontaneous recovery. Findings from recent observational studies suggest that some patients may benefit from early physical therapy, but only for a short period.

Researchers at the University of Utah, Salt Lake City, randomly assigned 220 patients with recent-onset LBP to early physical therapy (n = 108; consisted of 4 physical therapy sessions [manipulation and exercise]), or usual care (n = 112; no additional interventions during the first 4 weeks). All participants received back pain related education. One-year follow-up was completed by 207 participants (94 percent).

For the primary study outcome, early physical therapy showed improvement compared to usual care on a measure of disability after 3 months. A significant difference was not found for disability between groups at 1-year follow-up. There was no improvement in pain intensity at 4-week, 3-month, or 1-year follow-up. Most differences between groups were modest. There were no differences in health care utilization at any point.  Furthermore, differences were mostly undetectable after 12 months.