Back Pain, Early Physical Therapy Not Linked to Better Results

Does timing really make an impact when it comes to treating back pain? A new study weighed in on the importance early initiation of therapy in this patient population.

Researchers from the University of Washington in Seattle evaluated if sooner really is better when it comes to relieving back pain through physical therapy. Results showed that for older adults, time is not necessarily of the essence for better clinical outcomes.

A total of 3,705 patients, who were at least 65-years-old, with new reports of back pain were included in the analysis. They were randomized to either start physical therapy early (0 to 28 days) or later (three to six months) from the point of doctor visit.

“We restricted the later phase analysis to patients with pain greater than two of 10 and an RMDQ [Roland Morris Disability Questionnaire] score greater than four to create a subsample of patients with continuing clinically important back pain,” the authors wrote in The Spine Journal.

By using propensity score matching and multiple linear regression, the team was able to gather the sensitivity score difference between the groups. At the 12-month mark those who began early physical therapy reported more improved function and less back pain by 1.1 on the RMDQ scale. Also, a greater “dose” of physical therapy in the early group was linked with better function. However, there did not appear to be a difference between patients who started treatment at three and six months.

“The odds of a 30% improvement in function or pain were not different between these matched groups at 12 months,” the team verified, “but the early [physical therapy] group had increased odds of a 50% improvement in function at 12 months.”

The researchers concluded that there were minimal differences in pain and function between the early and later physical therapy groups. Although a second analysis indicated that those who begin the treatment early “may be somewhat more likely” to have a function improvement by 50% after one year, there was not any statistically significant evidence backing it up.