Background/Purpose: Chronic low back pain has been the subject of many studies in medicine and physical therapy for over half a century. Clinical practice guidelines based on evidence have not changed much in the past 30 years, recommending patient education and self-management, and generalized exercise programs. Other treatments such as orthotics, acupuncture, electrotherapies are not recommended, whereas manual therapy, psychological therapies are considered helpful in combination with patient education and exercise. Persons with chronic low back pain often consult a physical therapist. The purpose of our study was to determine whether physical therapists provide recommended treatments for a typical case of chronic low back pain. We also sought to identify factors associated with the use of some specific types of treatment, notably, electrotherapy (which is not recommended) and manual therapy (which can be recommended together with exercise).

Methods: We sent an online survey to physical therapists in the province of Quebec, Canada. The survey contained clinical vignettes of four different cases, one of which was chronic low back pain with sciatica. Participants were asked about what kind of treatment they would provide for this patient showing typical signs and symptoms of chronic low back pain with sciatica as well as whether they would refer the patient to another professional. Descriptive statistics were used to illustrate the proportions for each treatment chosen by physical therapists. We explored associations between choice of treatments with physical therapists’ demographic and practice related factors, using inferential statistics and regression analyses.

Results: There were 176 physical therapists who responded, 41 who identified as male (23.3%) and the majority (63.6%) worked in private practice. The vast majority of physical therapists would provide education (93.8%) and exercise (81.8% mobility exercises, and 65.9% strengthening exercises). Nearly 73% would use manual therapy while 46% would use electrotherapy. The percentage who selected manual therapy together with any type of exercise was 72.7. Many thought it would be important to refer to another health professional such as a family physician (70.6%), a physical therapist who specializes in backs (62.1%), but not to a rheumatologist (0.4%). Regression analyses revealed certain factors associated with the selection of various treatments. Physical therapists with less experience were more likely to select manual therapy (p=0.01) while those working in rural areas were more likely to choose electrotherapy (p=0.03).

Conclusion: Physical therapists would treat a patient with chronic low back pain with the recommended treatments, i.e. education and exercise. Most would also use manual therapy, and for the majority, this was in conjunction with both education and exercise. However, there is a need for improved knowledge translation/education since nearly half would still use the non-recommended electrotherapy treatment.

« Back to ACR Convergence 2021

ACR Meeting Abstracts - https://acrabstracts.org/abstract/do-physical-therapists-use-recommended-treatments-for-chronic-low-back-pain/