Teaching patients self-care for low back pain does not save costs.
Teaching self-care to patients does not achieve clinically important outcomes.
Patients receiving supervised exercise plans prove 1.8 times more likely to achieve clinically significant improvement at 10 weeks.
Patients with supervised therapeutic exercise rate much higher in patient satisfaction.
Nonspecific low back pain (LBP) ranks as one of the most common and costly musculoskeletal disorders, and the expense of LBP continues to rise. The majority of costs related to LBP can be attributed to recurrence and chronicity. One often-recommended solution for this problem is the teaching of self-care in the medical setting.1-2 Advice as treatment for back pain persists despite the fact that a 2012 systematic review finds self-care alone unable to achieve clinically important results.3 Since the effects of self-care are clinically insignificant, is offering self-care without clinical supervision a lesser intervention than a referral to physical therapy? Recently, Physical Therapy and Rehabilitation published a randomized trial addressing this question.4
Researchers randomized 59 patients with chronic low back pain into a supervised group and a home exercise group. The home exercise group received consultation and training sessions at day one and two weeks later. In addition to advice on staying active and posture, they received personal and printed instructions in a fairly mainstream exercise therapy program. The program included stabilization exercises, cat-camel, spinal flexion / extension from quadruped position, curl-up exercises, “dead bug” exercises, the side-support exercise, etc. All participants received exercise logs. The supervised exercise group received the exact same treatment protocols, except they were scheduled for clinic appointments multiple times per week. At six-week follow-up, improvement in pain and physical function was significantly better among the patients receiving physical therapist supervision.
The researchers noted poor adherence rates to home exercise programs as demonstrated by the patients’ exercise logs. The home exercise patients showed 32% adherence compared to 36% in the supervised group. While neither adherence rate is sufficient, the supervised group had enough clinic visits to create the needed exercise frequency. A previous study confirms a correlation between degree of home exercise adherence and clinical outcomes,5 and the adherence rates in the present study are consistent with home exercise adherence rates observed previously.6 Researchers additionally hypothesize that supervision ensures correct performance of the exercises and the most efficient progression of difficulty.
The current study adds to the results of the recently published, first randomized trial on this subject.7 In that study, researchers randomized 300 patients to 16 different therapy practices. Similarly, those researchers found that patients receiving more supervision achieved a greater level of improvement. Statistically significant differences in favor of physical therapy persisted at the 52-week follow-up. For instance, at ten weeks, patients receiving physical therapy proved 1.8 times more likely to demonstrate clinically significant improvement in back pain ratings. On a one-to-four scale, median patient satisfaction in the physical therapy group was a four compared to a two in the advice group.
The current evidence suggests that offering good home exercise plans achieves lesser outcomes than referrals to physical therapy.
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Experience, consistency, effectiveness – those are the hallmarks of the rehab your patients will receive at Back to Action. In addition to ample professional experience before joining our team, BTA therapists average nine years tenure each with Back to Action. This speaks to the quality of our workplace and the consistency you can count on when referring patients to Back to Action.
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- Maher C, Williams C. Managing low back pain in primary care. Aust Prescr. 2011; 34: 128-32.
- Dagenais S, Tricco A, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J. 2010; 10: 514-29.
- Oliveira V, Ferreira P, Maher C, et al. Effectiveness of self-management of low back pain: systematic review with meta-analysis. Arthritis Care & Research. 2012; 64 (11): 1739-1748.
- Ammar T. A randomized comparison of supervised clinical exercise versus a home exer-cise program in patients with chronic low back pain. Physical Therapy and Rehabilitation. 2017 Aug; 4( 1): 7.
- Jordan J, Holden M, Mason E, Foster N. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2010; CD005956.
- Holden M, Haywood K, Potia T, et al. Recommendations for exercise adherence measures in musculoskeletal settings: a systematic review and consensus meeting (protocol). Syst Rev. 2014; 3: 10.
- Ford J, Hahne A, Surkitt L, et al. Individualised physiotherapy as an adjunct to guideline-based advice for low back disorders in primary care: a randomised controlled trial. Br J Sports Med. 2016; 50: 237-245.