Eli's Rehab Report

Question: Is physical therapy an effective non-surgical treatment option for low back pain (LBP)?

Answer: Yes and no, according to a study published in a recent edition of the journal Spine.

The study looked at the data of 4,597 patients who underwent physical therapy for non-operative LBP treatment to determine the effectiveness of PT for these LBP diagnoses. The study used the Oswestry Disability Index (ODI) and the Numeric Pain Rating Scale (NPRS) to measure outcomes pre- and post-treatment during activity, and the NPRS during rest. Results showed that a significant percentage of this population did not demonstrate a minimal clinically important difference (MCID) after therapy.

About 28.5 percent of patients met the MCID for improvement in ODI, with a presence of night symptoms, obesity, and smoking as predictors of treatment failure. Fifty-nine percent of patients met the MCID threshold for improvement in resting NPRS, with a history of venous thromboembolism, night symptoms, psychiatric disease, workers’ compensation status, smoking, and obesity predictive of treatment failure. Sixty percent of patients met the MCID for improvement in activity NPRS, with night symptoms, workers’ compensation status, and smoking predictive of treatment failure.

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While the findings of the study seem to question the effectiveness of physical therapy for common LBP diagnoses, the decision to prescribe PT for LBP should be determined on a patient-by-patient basis, the study’s authors conclude.

From a safety standpoint, according to the authors of the study, physical therapy is “vastly superior” to interventional treatments such as injections or surgery. Although the likelihood of achieving a MCID may be considered low, the likelihood for harm from complication is also low, at least in comparison to other treatments.

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The cost-effectiveness of physical therapy for common LBP diagnoses, however, isn’t so clear, study authors warn. Other studies have suggested that PT for LBP may account for more than three times the cost of surgical treatment.

Note: Read the Spine study here: www.medscape.com/viewarticle/867581_1.