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| Effectiveness and downstream healthcare utilization for patients that received early physical therapy versus usual care for low back pain: a randomized clinical trial [with consumer summary] |
| Rhon D, Miller R, Fritz J |
| Spine 2018 Oct 1;43(19):1313-1321 |
| clinical trial |
| 7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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STUDY DESIGN: Randomized controlled trial. OBJECTIVE: Compare early physical therapy versus usual care in patients with low back pain. SUMMARY OF BACKGROUND DATA: Early physical therapy (PT) has been associated with reduced downstream healthcare utilization in retrospective studies, but not investigated prospectively in the military health system. METHODS: Military service members seeking care from a general practitioner were recruited. Patients attended a 20-minute self-management class with focus on psychosocial resilience and then randomized to usual care only (UC) versus immediately starting a 3-week physical therapy program (PT). Primary outcome was the Oswestry Disability Index at 1 year. Secondary outcomes included Oswestry scores at 4 and 12-week follow-up, numeric pain rating scale, global rating of change, and healthcare utilization at 1 year. ANCOVA was used to compare differences between groups, significance set at 0.05. TRIAL REGISTRATION: ClinicalTrials.gov NCT01556581. RESULTS: 119 patients (mean age 27.2 years; mean BMI 27.8 kg/m2; 15.1% female) enrolled (61 randomized to UC; 58 to PT). No between-group differences found on the Oswestry after 1 year. A between-group difference in Oswestry was present at 4 weeks (mean difference 4.4; 95% CI 0.41 to 10.1; p = 0.042) favoring PT. Total 1-year mean healthcare costs did not differ significantly between groups (UC $5,037; 95% CI $4,171 to $6,082 and PT $5,299; 95% CI $4,367 to $6,431). The portion of total mean healthcare costs related to low back pain was lower for UC ($1,096; 95% CI $855 to $1,405) compared to PT ($2,016, 95% CI $1,570 to $2,590). CONCLUSIONS: There was no difference between usual care and early PT after 1 year. PT provided greater improvement in disability after 4 weeks. As both groups improved, the impact of the education may have been underestimated. Patients in the PT group utilized greater back-pain-related healthcare resources, but overall healthcare costs did not differ compared to UC. LEVEL OF EVIDENCE: 2.
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