OBJECTIVE: To synthesize literature about the impact of early physical therapy (PT) for acute low back pain (LBP) on subsequent health services utilization (HSU), compared to delayed PT or usual care. DATA SOURCES: Electronic databases (Medline, CINAHL, and Embase) were searched from their inception to May 2018. STUDY SELECTION: Study selection included randomized control trials and prospective and retrospective cohort studies that investigated the association between early PT and HSU compared to delayed PT or usual care. Two independent authors screened titles, abstracts, and full text articles for inclusion based on eligibility criteria, and a third author resolved discrepancies. Eleven out of 1,146 articles were included. DATA EXTRACTION: Two independent reviewers extracted data on participants, timing of PT, comparisons to delayed PT or usual care, and downstream HSU, and a third reviewer assessed the information to ensure accuracy and reach consensus. Risk of bias was assessed with the Downs and Black checklist using the same method. DATA SYNTHESIS: Eleven studies met eligibility criteria. Early PT is within 30 days of the index visit for acute LBP. Five out of six studies that compared early PT to delayed PT found that early PT reduces future HSU. Random effects meta-analysis indicated a significant reduction in opioid use, spine injection, and spine surgery. Five studies compared early PT to usual care and reported mixed results. CONCLUSIONS: Early PT for acute LBP reduces HSU and cost, reduces opioid use, and may improve healthcare efficiency. This review may assist patients, healthcare providers, healthcare systems, and 3rd party payers in making decisions for the treatment of acute LBP.

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