Physiotherapy and low back pain in the injured worker: an examination of current practice during the subacute phase of healing.

PURPOSE: To describe current physiotherapy practice for injured workers with subacute low back pain (SA-LBP).
METHOD: A chart audit of discharged workers was conducted over three episodes of care: 4-6 weeks (T1), 6-8 weeks (T2), and 8-10 weeks (T3) post-injury. The prevalence and reproducibility of parameters for common interventions were calculated as the percentage of active charts over time. Focus groups were used to validate audit results and deepen our understanding of practice.
RESULTS: In all, 164 charts were audited. The most prevalent interventions were (1) for manual therapy, joint mobilization and traction; (2) for electrophysical agents (EPAs), heat, ultrasound, and interferential therapy; and (3) for exercise, core stabilization exercises. Transcript analyses revealed that participants viewed injured workers with SA-LBP in a positive light, emphasized the importance of physiotherapy, and discussed SA-LBP in five themes: time frame, non-specific diagnosis, mixed client outlook, change in pain presentation, and the transition from a passive to a more active treatment approach.
CONCLUSIONS: The pattern of decreasing passive and increasing active interventions is consistent with the focus-group participants' description of how they approach treatment of clients with SA-LBP. Also noted was a higher prevalence of interventions poorly supported by evidence and lower prevalence of interventions well supported by evidence.