Acute low back pain, early treatment
Researches often give new ideas. An international randomised controlled trial has shown that early physiotherapy treatment gives better results for acute low back pain than waiting six weeks (Wand et al., 2004, Early intervention for the management of acute low back pain; A single blind randomised controlled trial of biopsychosocial education, manual therapy and exercise. Spine: in press).
Draft Australian and Dutch guidelines for acute low back pain suggest a 'wait and see' approach for the first six weeks, while clinical standards in the UK and the USA generally recommend early physical intervention. Which gives better results? In the absence of direct comparisons in the literature, Dr. Benedict Wand helped set up and run a randomised controlled trial to compare the two models of care.
Patients with acute low back pain attending the physiotherapy outpatients department of a London hospital were randomly assigned to an 'assess/advise/treat' or an 'assess/advise/wait' group. Both groups received advices on staying active, but the 'treat' group received immediate physiotherapy while the 'wait' group were given an appointment for six weeks' later. All 102 patients in the study were followed up at six weeks, three months and six months from the baseline.
In Australia and overseas, clinical guidelines for acute low back pain recommend that assessment should address psychological, occupational and socio-economic factors, since these tend to be more important risk-factors for the development of chronic (long-standing) disability than biomedical symptoms and signs. So assessment in this study covered not just reported pain and disability, but mood, general health and quality of life.
The early physiotherapy group reported significantly less disability at the six week mark than the delayed treatment group, but at long-term follow-up there was no significant difference. Long-term psycho-social factors were, however, much improved. At six weeks, the 'assess/advice/treat' group demonstrated greater improvements in mood, general health and quality of life than patients in the 'assess/advise/wait' group, and they remained significantly better in these areas at long-term follow-up.
The study indicates that early active intervention with physiotherapy gives better results for acute low back pain patients than delayed treatment. Not only does it reduce short-term disability, but it offers both short-and long-term beneficial effects on mood and general health, which are important determinants of successful longer term self management strategies.
Luck LI
Musculoskeletal Physiotherapist
Draft Australian and Dutch guidelines for acute low back pain suggest a 'wait and see' approach for the first six weeks, while clinical standards in the UK and the USA generally recommend early physical intervention. Which gives better results? In the absence of direct comparisons in the literature, Dr. Benedict Wand helped set up and run a randomised controlled trial to compare the two models of care.
Patients with acute low back pain attending the physiotherapy outpatients department of a London hospital were randomly assigned to an 'assess/advise/treat' or an 'assess/advise/wait' group. Both groups received advices on staying active, but the 'treat' group received immediate physiotherapy while the 'wait' group were given an appointment for six weeks' later. All 102 patients in the study were followed up at six weeks, three months and six months from the baseline.
In Australia and overseas, clinical guidelines for acute low back pain recommend that assessment should address psychological, occupational and socio-economic factors, since these tend to be more important risk-factors for the development of chronic (long-standing) disability than biomedical symptoms and signs. So assessment in this study covered not just reported pain and disability, but mood, general health and quality of life.
The early physiotherapy group reported significantly less disability at the six week mark than the delayed treatment group, but at long-term follow-up there was no significant difference. Long-term psycho-social factors were, however, much improved. At six weeks, the 'assess/advice/treat' group demonstrated greater improvements in mood, general health and quality of life than patients in the 'assess/advise/wait' group, and they remained significantly better in these areas at long-term follow-up.
The study indicates that early active intervention with physiotherapy gives better results for acute low back pain patients than delayed treatment. Not only does it reduce short-term disability, but it offers both short-and long-term beneficial effects on mood and general health, which are important determinants of successful longer term self management strategies.
Luck LI
Musculoskeletal Physiotherapist