Alternative pathways in care for patients with low back pain
This study found that - when compared with patients with low back pain (LBP) who first consulted a physiatrist before starting physiotherapy - patients enrolled in a guideline-based program emphasising early physiotherapy had fewer medical appointments (nearly 60%), showed improved physical function, and imaging and injection rates were lower.
The authors point out, however, that these results were obtained in a single health system and may not be generalisable.
LBP is the most frequent musculoskeletal complaint worldwide, and remains a major source of disability.
Despite the amount of research and financial resources devoted, prevalence and utilisation rates for low-value, high-cost procedures including advanced imaging, epidural injections and surgery are rising and patient-centered outcomes are not improving.
A total of 124 patients out of 1556 with LBP as main complaint, who were scheduled for a physiatrist appointment were enrolled in the RapidAccess program, which emphasised early guideline-driven physiotherapy care.
RapidAccess participants demonstrated improvement in physical function, reduced medical appointments, and fewer injection and imaging rates with physiotherapy management.
Although the overall program reach and adoption were far from ideal and challenging to maintain, this preliminary study shows that the implementation of a guideline-based program such as RapidAccess may have a positive impact on patient-centered outcomes.
Expert opinion by José Pedro Correia
Despite widespread recommendations by multiple institutional guidelines, various low-value and nocebo interventions continue to be used in LBP care.
This study shows that early physiotherapy intervention reduces the use of these interventions, which may have a positive impact in both patient care and use of medical resources.
Naturally, many barriers remain to the implementation of these measures, such as healthcare system features, tradition, and reduced patient and healthcare professional education.
> From: Magel et al., Phys Ther 98 (2018) 1000-1009. All rights reserved to the American Physical Therapy Association. Click here for the online summary.