Julie M Fritz1, Elizabeth Lane2, Molly McFadden3, Gerard Brennan4, John S Magel2, Anne Thackeray2, Kate Minick5, Whitney Meier6, Tom Greene3. 1. College of Health, University of Utah, Salt Lake City, Utah (J.M.F.). 2. University of Utah, Salt Lake City, Utah (E.L., J.S.M., A.T.). 3. School of Medicine, University of Utah, Salt Lake City, Utah (M.M., T.G.). 4. Rehabilitation Services, Intermountain Healthcare, Salt Lake City, Utah (G.B.). 5. Intermountain Healthcare, Salt Lake City, Utah (K.M.). 6. University of Utah Health, Salt Lake City, Utah (W.M.).
Abstract
BACKGROUND: Few studies have examined primary care management for acute sciatica, including referral to physical therapy. OBJECTIVE: To evaluate whether early referral to physical therapy reduced disability more than usual care (UC) alone for patients with acute sciatica. DESIGN: Randomized controlled clinical trial. (ClinicalTrials.gov: NCT02391350). SETTING: 2 health care systems in Salt Lake City, Utah. PATIENTS: 220 adults aged 18 to 60 years with sciatica of less than 90 days' duration who were making an initial primary care consultation. INTERVENTION: All participants received imaging and medication at the discretion of the primary care provider before enrollment. A total of 110 participants randomly assigned toUC were provided 1 session of education, and 110 participants randomly assigned toearly physical therapy (EPT) were provided 1 education session and then referred for 4 weeks of physical therapy, including exercise and manual therapy. MEASUREMENTS: The primary outcome was the Oswestry Disability Index (OSW) score after 6 months. Secondary outcomes were pain intensity, patient-reported treatment success, health care use, and missed workdays. RESULTS: Participants in the EPT group had greater improvement from baseline to 6 months for the primary outcome (relative difference, -5.4 points [95% CI, -9.4 to -1.3 points]; P = 0.009). The OSW and several secondary outcomes favored EPT after 4 weeks. After 1 year, between-group differences favored EPT for the OSW (relative difference, -4.8 points [CI, -8.9 to -0.7 points]) and back pain intensity (relative difference, -1.0 points [CI, -1.6 to -0.4 points]). The EPT group was more likely to self-report treatment success after 1 year (45.2%) than the UC group (27.6%) (relative risk, 1.6 [CI, 1.1 to 2.4]). There were no significant differences in health care use or missed workdays. LIMITATION: The patients and providers were unblinded, and specific physical therapy interventions responsible for effects could not be determined. CONCLUSION: Referral from primary care to physical therapy for recent-onset sciatica improved disability and other outcomes compared with UC. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
RCT Entities:
BACKGROUND: Few studies have examined primary care management for acute sciatica, including referral to physical therapy. OBJECTIVE: To evaluate whether early referral to physical therapy reduced disability more than usual care (UC) alone for patients with acute sciatica. DESIGN: Randomized controlled clinical trial. (ClinicalTrials.gov: NCT02391350). SETTING: 2 health care systems in Salt Lake City, Utah. PATIENTS: 220 adults aged 18 to 60 years with sciatica of less than 90 days' duration who were making an initial primary care consultation. INTERVENTION: All participants received imaging and medication at the discretion of the primary care provider before enrollment. A total of 110 participants randomly assigned to UC were provided 1 session of education, and 110 participants randomly assigned to early physical therapy (EPT) were provided 1 education session and then referred for 4 weeks of physical therapy, including exercise and manual therapy. MEASUREMENTS: The primary outcome was the Oswestry Disability Index (OSW) score after 6 months. Secondary outcomes were pain intensity, patient-reported treatment success, health care use, and missed workdays. RESULTS:Participants in the EPT group had greater improvement from baseline to 6 months for the primary outcome (relative difference, -5.4 points [95% CI, -9.4 to -1.3 points]; P = 0.009). The OSW and several secondary outcomes favored EPT after 4 weeks. After 1 year, between-group differences favored EPT for the OSW (relative difference, -4.8 points [CI, -8.9 to -0.7 points]) and back pain intensity (relative difference, -1.0 points [CI, -1.6 to -0.4 points]). The EPT group was more likely to self-report treatment success after 1 year (45.2%) than the UC group (27.6%) (relative risk, 1.6 [CI, 1.1 to 2.4]). There were no significant differences in health care use or missed workdays. LIMITATION: The patients and providers were unblinded, and specific physical therapy interventions responsible for effects could not be determined. CONCLUSION: Referral from primary care to physical therapy for recent-onset sciatica improved disability and other outcomes compared with UC. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
Authors: Isabelle Boutron; Douglas G Altman; David Moher; Kenneth F Schulz; Philippe Ravaud Journal: Ann Intern Med Date: 2017-06-20 Impact factor: 25.391
Authors: Lisbeth Hartvigsen; Lise Hestbaek; Charlotte Lebouef-Yde; Werner Vach; Alice Kongsted Journal: BMC Musculoskelet Disord Date: 2017-03-31 Impact factor: 2.362
Authors: Kika Konstantinou; Kate M Dunn; Reuben Ogollah; Martyn Lewis; Danielle van der Windt; Elaine M Hay Journal: Spine J Date: 2017-11-21 Impact factor: 4.166
Authors: Brittany L Sisco-Taylor; John S Magel; Molly McFadden; Tom Greene; Jincheng Shen; Julie M Fritz Journal: Pain Med Date: 2022-05-30 Impact factor: 3.637
Authors: Howard S Kim; Kayla M Muschong; Ivy L Fishman; Jacob M Schauer; Amee L Seitz; Kyle J Strickland; Bruce L Lambert; Danielle M McCarthy; My H Vu; Jody D Ciolino Journal: BMJ Open Date: 2022-05-24 Impact factor: 3.006
Authors: Robson Massi Bastos; Claudia Regina Moya; Rodrigo Antunes de Vasconcelos; Leonardo Oliveira Pena Costa Journal: J Man Manip Ther Date: 2022-01-24