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

Study Says Cost Savings of Physical Therapy for LBP Are Significant

When it comes to physical therapy for treatment of low back pain (LBP), Medicare is getting a bargain, according to authors of a new study. Researchers say that not only is physical therapy cheaper than injections or surgery in the short-term, it’s an approach that is likely to save on treatment costs for at least a year after initial diagnosis, with average savings of 18% over treatments that begin with injections and 50% over treatments that begin with surgery.

The study, commissioned by the Alliance for Physical Therapy Quality and Innovation (APTQI), focused on Medicare A and B claims data from 472,000 beneficiaries who received a diagnosis of LBP and began treatment between February and October of 2014. Researchers from the Moran Company tracked 3 treatment paths—physical therapy, injections, and surgery—and compared total costs of initial treatment as well as total costs for 12 months after diagnosis. The study also included an analysis of cost differences associated with how soon physical therapy was initiated after diagnosis, the physical therapist interventions used, and relationships between the use of physical therapy and the referring health care provider.

Full story at APTA

Spinal manipulation treatment for low back pain associated with modest improvement in pain, function

Among patients with acute low back pain, spinal manipulation therapy was associated with modest improvements in pain and function at up to 6 weeks, with temporary minor musculoskeletal harms, according to a study published by JAMA.

Back pain is among the most common symptoms prompting patients to seek care. Lifetime prevalence estimates of low back pain exceed 50 percent. Treatments for acute back pain include analgesics, muscle relaxants, exercises, physical therapy, heat, spinal manipulative therapy (SMT) and others, with none established as superior to others. Paul G. Shekelle, M.D., Ph.D., of the West Los Angeles Veterans Affairs Medical Center, Los Angeles, and colleagues conducted a review and meta-analysis of previous studies to assess the effectiveness and harms associated with spinal manipulation compared with other nonmanipulative therapies for adults with acute (six weeks or less) low back pain.

Full story of spinal manipulation therapy for LBP at Science Daily

Revised Physician Guidelines Shift to Non-Drug Approaches as First-Line Treatment for LBP

In brief:

  • In a revision of clinical guidelines, the American College of Physicians is recommending nonpharmacologic approaches over the use of medications as first-line treatment for acute, subacute, and chronic LBP.
  • Changes are based in part on new evidence showing that acetaminophen and antidepressants were no better than placebos.
  • Guidelines recommend that physicians advise patients that pain is likely to diminish through exercise and maintenance of as many daily activities as possible.

The latest advice on low back pain (LBP) from the American College of Physicians (ACP) makes it clear: patients with acute LBP will generally improve over time regardless of treatment, and that when treatments are necessary, nondrug approaches including exercise are preferred for all but the most stubbornly chronic manifestations of the condition. The new guidelines represent a shift from ACP’s previous position, which called for the use of medication as part of first-line treatment.

Full story on use of medication as first-line treatment for LBP at APTA

Survey Reveals High Rates of Disagreement Among Spine Surgeons on LBP Treatment

Ask 2 spine surgeons for a recommendation on what kind of spine surgery to have for low back pain (LBP)—or whether to have surgery at all—and you’re likely to get 2 different answers, according to results of a new survey that found high rates of disagreement, with some significant regional variability.

In an article published recently in Spine, researchers shared results of a study in which 445 spine surgeons across the US (75% orthopedic surgeons, 25% neurological surgeons) were asked to respond to 2 case scenarios and related imaging. Scenario 1 described a 44-year-old man with mechanical LBP refractory to conservative management, no leg pain, and discogram at L4-5 causing concordant pain; L3-4 and L5-S1 were negative controls. Scenario 2 presented the same patient, but with discogram at L4-5 and L5-S1 causing concordant pain, and L3-4 a negative control. The surgeons were instructed to provide their recommendation by choosing 1 of 4 fusion surgeries, or no surgery at all.

Full story of survey disagreement on LBP treatment at APTA

Study: Could Reducing Smoking, Drinking, Physical Inactivity Affect Prevalence of LBP?

Authors of a new study say that public health efforts to reduce smoking, alcohol use, obesity, physical inactivity, and irregular sleep may also pay off in reducing the prevalence of low back pain (LBP).

In an article e-published ahead of print in Spine, researchers shared findings from what they believe is the first study to document the association between behavior-related factors and LBP in US adults. Authors gathered data from a series of cross-sectional surveys pulled from the National Health Interview Survey (NHIS), a population that featured adults between the ages of 18 and 85, with a population size totaling 122,337.

When authors cross-referenced individuals with LBP with various behaviors, they found some telling connections. Among them:

Full story of smoking, drinking, and physical inactivity affect LBP at APTA

Separate Studies Support Exercise to Treat, Prevent LBP

Research continues to support the effectiveness of exercise when it comes to low back pain (LBP)—not only as a way to treat existing LBP, but as a way to prevent it.

A new systematic review and meta-analysis in JAMA Internal Medicine assessed research into the value of exercise as a way to prevent episodes of LBP. It found that exercise alone was linked to a 35% reduction in risk, while a combination of exercise and education was associated with a 45% risk reduction for up to 1 year. The use of exercise was also found to result in a 78% reduction in sick leave for LBP.

The review was based on 23 published studies involving 30,850 participants, and looked at the preventive qualities not only of exercise and education (both combined and separately), but also of back belts and orthotic shoe insoles. In the end, only exercise was linked to a reduced risk of LBP: authors of the study found that while education helped to further reduce that risk when combined with exercise, education alone didn’t seem to have much effect.

Full story of exercise to treat LBP at APTA

Patients, PTs Generally Agree on LBP Triggers

While patient education can be an important part of treatment for low back pain (LBP), physical therapists (PTs) and physical therapist assistants (PTAs) may not have as much educating to do when it comes to triggers for the condition. According to a new study from Australia, patients’ understanding of what causes sudden-onset acute LBP is fairly consistent with PTs’ views.

For the study, e-published ahead of print in Spine, researchers surveyed 102 PTs and 999 patients with sudden onset acute LBP to find out perceptions around common triggers. The groups were asked slightly different questions: patients were asked what they thought caused their own LBP episode, while the PTs were asked to list “the 5 most likely factors involving short-term exposure that are triggers for a sudden episode of LBP.”

Though the questions were different, the answers showed “remarkably similar” perceptions among both groups, according to the study’s authors.

Full story of LBP triggers at APTA

Study: For Best LBP Results, Take a PT’s Advice – Plus Customized Physical Therapy

The role of education and advice in the treatment of low back pain (LBP) may be important, but it’s probably not as effective as coupling that advice with physical therapy that’s been “individualized” to the particular kind of LBP a patient is experiencing, according to a new study from Australia.

Researchers focused on 300 patients, aged 18-65 (average age, 44.2) who had experienced LBP for between 6 weeks and 6 months. They split participants into 2 groups: 1 group received 2 30-minute education and advice sessions provided by a physical therapist (PT), plus 10 30-minute physical therapy sessions over 10 weeks; the other group received the education and advice sessions only. Results were e-published ahead of print in the British Journal of Sports Medicine.

Full story of customized physical therapy for LBP at APTA