Sooner is Better than Later – Physical Therapy for Low Back Pain

June 30, 2017 in STSMPT

Doctors at the University of Utah started an innovative but practical policy that is really helping people with low back pain. Dr. Michael Campian and colleagues noted that practice guidelines call for treatments in physical therapy as first-line approaches for low back pain, but the average patient was waiting four weeks or more before getting a physical therapy referral. Research also shows that the sooner you begin physical therapy after a flare-up of back pain, the better the short-term and long-term results. So the doctors at the University of Utah asked, “Why are we making patients wait to see a doctor before we recommend physical therapy?” They told their front desk staff that when people are making their doctor’s appointment for low back pain, to go ahead and offer them a physical therapy appointment right away. The results have been amazing.

Because some of their patients had insurance that requires a doctor’s order for physical therapy and others were allowed direct access, they ended up with an experimental group (immediate access) and a usual-care group. The immediate-access group saw a physical therapist within 72 hours. The usual-care group waited four weeks or more. The immediate access group achieved more than double the improvement in physical function. They also had fewer injections and orders for expensive imaging: x-rays (24% vs. 63%), MRIs (0 vs 16.9%), and injections (1.9% vs. 20.8%). The results really aren’t a surprise. Research has shown for years that physical therapy should start during the acute phase, as soon as possible during certain types of back pain. What is amazing is that a simple, clever idea like changing the way appointments are made with the front desk staff can double people’s functional improvement.

Source: Campian M, Hedin T, Hansen P, et al. Rapid access to physical therapy for low back pain: a continuous quality improvement project. Presented at: Annual Meeting of the Association of Academic Physiatrists. 2017; Sacramento, CA, USA.

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