Systematic Review: LBP Studies Make the Case for Early Physical Therapy

Authors of a new systematic review of 11 studies on low back pain (LBP) have found that despite sometimes-wide variation in research design, a picture of the value of early physical therapy for the condition is emerging—and the results are encouraging.

According to the review, e-published ahead of print in the Archives of Physical Medicine and Rehabilitation, evidence supports the cost-effectiveness and better patient outcomes of early physical therapy over later physical therapy for LBP, and even points to a correlation between early physical therapy and lower rates of opioid prescription overall. As for utilization and costs associated with early physical therapy versus so-called “usual care” (UC)? Early treatment by a physical therapist (PT) adhering to APTA guidelines could make a positive difference there as well, authors say, but that’s a harder question to answer definitively until studies become more uniform in terminology and design.

Full story at APTA

PTJ: Physical Therapy Continuity of Care Linked to Lower Rate of Surgery, Lower Costs

Patients with low back pain (LBP) who see a single physical therapist (PT) throughout their episode of care may be less likely to receive surgery and may have lower downstream health care costs, researchers suggest in a study published in the December issue of PTJ (Physical Therapy). “Limiting the number of physical therapy providers during an episode of care might permit cost savings,” authors write. “Health care systems could find this opportunity appealing, as physical therapy provider continuity is a modifiable clinical practice pattern.”

Authors examined data from nearly 2,000 patients in Utah’s statewide All Payer Claims Database (APCD) to look for associations between continuity of care for LBP patients and utilization of related services such as advanced imaging, emergency department visits, epidural steroid injections, and lumbar spine surgery in the year after the first primary care visit for LBP. APTA members John Magel, PT, PhDAnne Thackeray, PT; and Julie Fritz, PT, PhD, FAPTA, were among the authors of the study.

Patients were between the ages of 18 to 64 who saw a PT within 30 days of a primary care visit for LBP. Researchers excluded patients with certain nonmusculoskeletal conditions; neurological conditions, such as spinal cord injury, that could affect patient management; and “red flag” conditions such as bone deficit or cauda equina syndrome.

Full story at APTA

CSM Delivers: Aging

As the US population continues to age, physical therapists (PTs) and physical therapist assistants (PTAs) will take on an even more transformative role in the health of society. Are you ready?

The 2019 APTA Combined Sections Meeting, set for January 23-26 in downtown Washington, DC, can help keep you on top of some of the latest issues in healthy aging. Check out these suggestions, and find other relevant programming by searching the CSM programming page.

Geriatric Low Back Pain: Managing Influences, Experiences, and Consequences
This session focuses on the biological, psychological, cognitive, and social influences of geriatric low back pain (LBP), and presents a comprehensive model of geriatric LBP that accounts for the interface between pain and impaired movement, as well mobility and health risks associated with geriatric LBP. Find out about age-appropriate measurement tools and interventions for geriatric LBP and learn how to implement a comprehensive, standardized management approach that optimizes recovery and mitigates health risks associated with geriatric LBP. Friday, January 25, 8:00 am–10:00 am.

Full story at APTA

FLEX CEUs: New CEU Courses

LOW BACK PAIN: THE ROLE OF FEAR

Low back pain (LBP) is one of the most prevalent diseases in most developed and developing countries, and evidence suggests that psychosocial factors, especially fear-avoidance beliefs are important in predicting patients who will progress from an acute to a chronic stage, as well as failure of interventions.  The goals of this CEU course are to evaluate the relationship between trunk mechanical properties and psychological features in people with recurrent LBP, determine whether balance response of LBP patients is different from healthy controls under various conditions, and find out whether body sway is related to the fear of fall in LBP individuals.  Fear and psychological distress in regards to pain and disability is also discussed.

LOW LEVEL LASER THERAPY EFFECTS ON INFLAMMATION

Inflammation of the synovial membrane plays an important role in the pathophysiology of osteoarthritis (OA).  The goal of this CEU course is to evaluate the effects of low-level laser therapy (LLLT) on joint inflammation.

Free Continuing Education for Life!

Did you know that we have a program available that gives you free continuing education for life? If this sounds like something you’re interested in, just visit https://www.flextherapistceus.com/account-refer.php to get all the details.

Early physical therapy benefits low-back pain patients

Patients with low-back pain are better off seeing a physical therapist first, according to a study of 150,000 insurance claims.

The study, published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit—but a 19 percent higher probability of hospitalization.

The authors noted that a higher probability of hospitalization is not necessarily a bad outcome if physical therapists are appropriately referring patients to specialized care when low back pain does not resolve by addressing potential musculoskeletal causes first.

Full story at Medical Xpress

Patients with low-back pain benefit from early physical therapy

Patients with low-back pain are better off seeing a physical therapist first, according to a study of 150,000 insurance claims.

The study, published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit – but a 19 percent higher probability of hospitalization.

The authors noted that a higher probability of hospitalization is not necessarily a bad outcome if physical therapists are appropriately referring patients to specialized care when low back pain does not resolve by addressing potential musculoskeletal causes first.

Full story at news-medical.net

Rocker bottom shoes help reduce chronic low back pain

A new study confirms that rocker bottom shoes helps strengthen back muscles, improving the spine’s curvature and thus reducing low back pain.

Researchers of the Sports Physiotherapy master’s degree at Valencia’s CEU Cardenal Herrera university have confirmed, in a new study of their research work into back pain, that unstable shoes improve the strength of back muscles in order to maintain balance and stability when walking. This muscular strengthening contributes to reducing low-intensity chronic low back pain, which can be disabling for those who suffer it. The results of this new study, headed by CEU UCH teachers Juan Francisco Lisón and Pablo Salvador, co-authors of the first international study on this matter, have been published in the Q1 edition of scientific magazine Clinical Rehabilitation.

As the coordinator of the CEU UCH master’s degree, Pablo Salvador, explains, “patients with chronic low back pain are usually advised to perform exercises to strengthen the muscles in their back, which improve stability of the spine in the lower back area, although it is always hard to make sure they comply with this type of exercises. What this new study shows is that the use of unstable shoes for several hours during a patient’s day-to-day life, without any other specific exercises, effectively contributes to the muscular strengthening of their back and improves the degree of curvature of the spine in the lumbar area, thus helping to reduce chronic pain.”

Full story at Science Daily

How should you sleep if you have lower back pain?

Lower back pain not only affects a person’s daily life but can also disturb their sleep. Furthermore, poor bed posture can worsen or even cause backache. So, what are the best sleeping positions for lower back pain?

This article provides a guide to the six best sleeping positions for lower back pain, as well as offering advice on pillows and mattresses, sleep hygiene, and when to see a doctor.

The best sleeping positions

Not only can lower back pain get in the way of a good night’s rest, but poor sleeping posture may make the existing pain worse.

A poor sleeping position may even be the underlying cause of lower back pain. This is because certain positions can place unnecessary pressure on the neck, hips, and back.

Full story at Medical News Today

Study: Referral to Physical Therapy for LBP Reduces Odds of Later Opioid Prescription—Even When Patients Don’t Follow Up on the Referral

There’s solid evidence that physical therapy as a first-line approach for low back pain (LBP) improves outcomes, but not many studies have focused on the factors that are associated with referral to physical therapy in the first place, regardless of later participation in treatment. Now authors of a recent study believe they’ve found associations indicating that the very act of referral for physical therapy may point to the ways a primary care provider’s approach to LBP can affect patient perceptions and reduce odds of later opioid use, even when the patient doesn’t follow through with the referral.

The study, published in the Journal of the American Board of Family Medicine looked at data from 454 Medicaid enrollees who were initially treated by a primary care provider for LBP, of which 215 received a referral for physical therapy. While researchers were interested in differences between the referral and nonreferral groups, the target of their study was something they believe is missing in current research: an examination of the entire referral population, regardless of whether those patients followed up with actual physical therapy.

Full story at APTA

JAMA: Equipment Ownership, Prior Imaging Behavior Predict High Rates of Low-Value Imaging for LBP, Headache

Despite evidence showing that imaging for low back pain (LBP) and uncomplicated headache is not necessary, too many health care providers still order these services for their patients, who incur greater financial costs. In a new study published in JAMA Internal Medicine, researchers identified several factors associated with higher rates of low-value imaging—including whether the providers owned the imaging equipment.

Using 4 years’ worth of claims data from 1 insurer, authors analyzed clinician characteristics as predictors for imaging for uncomplicated back pain and headache—2 low-value services identified by the Choosing Wisely campaign guidelines as inappropriate for imaging.

Full story at APTA