Research Slightly Favors Early Physical Therapy for Low Back Pain

Should physicians prescribe early physical therapy or delay the method for low back pain? That is the question, and a new study has the answer.

A recent analysis from the University of Washington concluded that early physical therapy is no more effective than starting the treatment later for patients with low back pain (LBP). However, researchers from the University of Utah are challenging those results with a study published in The Journal of the American Medical Association.

Lead investigator Julie M. Fritz, PhD, PT, and colleagues evaluated 220 patients with recent-onset LBP who had not undergone treatment within the last six months. Ranging in age from 18 to 60, the participants were analyzed using the Oswestry Disability Index (ODI) and all had a score of at least 20. Symptom onset was less than 16 days prior to the study. They were randomly assigned to receive either four physical therapy sessions within the first four weeks (108 patients) or usual care with no treatment during the first four weeks (112 patients).

With higher scores indicating greater disability, the researchers surveyed ODI scores after four weeks, three months, and one year. Pain Catastrophizing Scale (PCS) scores were also measured at those points. At baseline, the early physical therapy group had an average ODI score of 41.3 and the usual care group came in at 40.9. After four weeks, there was a significant 3.5 score difference between the groups. At the three-month mark, both groups experienced substantial reductions to 6.6 and 9.8, respectively.

“We found that patients in both groups improved rapidly. Rapid and substantial improvement by most patients with acute LBP limits treatment effects in early intervention studies,” the authors wrote. “We detected a modest difference favoring early physical therapy that was better than the natural history of acute LBP for the primary outcome at three-month follow-up. However, the between-group difference did not achieve the threshold for minimum clinically important difference. Furthermore, differences were mostly undetectable by one year.”

PCS scores slightly improved in the early physical therapy group after four weeks and three months, but not one year. However, statistical improvement in pain intensity or health care utilization was not observed at any point during the study.

“Among adults with recent-onset LBP, early physical therapy resulted in statistically significant improvement in disability, but the improvement was modest and did not achieve the minimum clinically important difference compared with usual care,” the team summed up.