Lower back pain is an extremely common ailment experienced by approximately 84% of the general population at some point in their lifetime. It’s one of the most common reasons people consult their physician or seek out a physical therapist.
Because lower back pain is associated with significant healthcare costs, there is some debate about the best prevention and treatment strategies.
A recent study published in PLOS ONE aimed to evaluate whether physical therapy guidelines given to patients were actually effective.
Earlier Intervention Could Be Necessary
Though there are a variety of professionals involved in the treatment of musculoskeletal disorders, physical therapists are a significant contributor in this area.
In many cases though, patients are not being referred to a physical therapist for 2 to 4 weeks. This waiting period is left open for those who spontaneously recover, which does occur in some cases. However, studies have shown that early intervention, even in such cases, could prevent chronic issues and produce significant cost savings.
Evidence Based Practice
The study reports that while patients are being treated for lower back pain, only an average 30% of therapists are adhering to evidence based guidelines. In many cases patients are receiving care which is considered ‘non-adherent care.’
It is generally agreeable that an active approach to lower back pain treatment is more effective that bed rest or passive modalities. Generally, this active approach includes therapeutic exercises where the goal is to educate the patient to be involved in their recovery in order to regain their condition.
According to the PLOS ONE study, there are 4 primary reasons evidence based practice is not utilized:
- Lack of understanding of clinical practice guidelines
- Compatibility of guidelines with current practices in place
- Level of perceived relevance of guidelines to the clinicians
- Level of agreement with clinical practice guidelines
Comparison of Adherent and Non-Adherent Approaches on Patient Outcomes
The outcomes in patients who do receive adherent care compared to those who don’t, are as follows:
- Patients required 1-9 fewer physical therapy visits
- 4-10% of patients required less prescription medication
- 6% of patients had fewer subsequent visits to the physician
- 3% less emergency department care within 18 months of first episode
- 7% of patients have less utilization of advanced imaging such as MRI and CT scans
- 5-7% of patients have less injection procedures
These results confirm that evidence based practice produces greater outcomes for patients.
The results of evidence based practice could also significantly reduce healthcare costs from physical therapy visits, medications, inpatients costs, that is estimated between $300 to $1300 per patient.