No Early Physical Therapy in Acute Low Back Pain

Background:  Imaging, opioids and surgical interventions for LBP is expensive and no associated with improved outcomes.  Clinical practice guidelines recommend against early PT use to avoid these interventions. (Ann Intern Med 2007; 147:478).
Utah study of n = 220 adults (mean 37 yo) with LBP < 16 days duration without radicular sxs below the knees.
Randomized to PT or usual care.  PT started within 4 d of enrollment, 4 sessions over 3 weeks including spinal ROM exercises, core strength, home exercises.  Both groups encouraged to exercise and educated on favorable prognosis.
Adherence to PT was nearly 100%.  Blinded assessments of outcomes at 1mo, 3 most and 12 mos.
Mixed results, small statistically significant results favoring PT, but no clinically important differences.
Conclusion:  Don’t order early PT in acute LBP patients – little or no clinical benefit from it.
JAMA 2015 Oct 13; 314:1459.

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