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Early physiotherapy referral ‘best for back pain’

GPs referring patients with low back pain for urgent physiotherapy halve the chances of that patient having to undergo surgery or steroid injections, say researchers.

Their study showed referral to a physiotherapist within two weeks can ‘profoundly’ cut care costs and the chances of a patient having to see their GP again.

NICE guidance currently advocates the use of painkillers and referral for manual therapy, structured exercise or acupuncture for low back pain, but does not suggest a period within which a patient must see a physiotherapist.

This study advocates quicker referral for physiotherapy in patients with low back pain in order to reduce the chances of more costly interventions later on.

The US researchers looked at 2,234 patients aged between 18-60 years who had a new consultation with a primary care physician with a diagnosis of low back pain and went on to have physiotherapy.

They measured the length of time it took before that patient was seen by a physiotherapist and correlated this with the interventions experienced by the patient.

They found patients who saw a physiotherapist within 14 days of visiting their GP were 74% less likely to visit a doctor again, 55% less likely to require major surgery and 58% less likely to require lumbar injections, when compared to patients receiving physiotherapy after 14 days.

This resulted in reduced care costs in this group, with total low back pain costs for patients receiving early physiotherapy $2,736 (£1,767) lower than patients receiving physiotherapy later.

Patients who received physiotherapy earlier also had a 50% decrease in costs for surgical procedures and a 41% decrease in imaging costs, compared with patients receiving physiotherapy later.

Study leader Dr Julie Fritz, associate professor of physiotherapy at the University of Utah, USA, said the findings could have a huge effect on the way GPs manage back pain.

She said: ‘It is increasingly evident that initial management decisions following a new low back pain consultation can have profound implications for outcomes and downstream costs.’

Dr Michael Burke, a GPSI in musculoskeletal medicine in the Wirral, said the study showed the benefits of early referral to a physiotherapist, but would be difficult to achieve a two-week wait in the NHS.

He said: ‘Currently it is very difficult for patients to access physiotherapy within 14 days, unless they are using the private sector.’

‘Current best practice for care of patients with low back pain would be a stratified approach, using prognostic screening with matched pathways, resulting in modest cost savings at one year, compared with the existing best practice.’

Spine 2012, online 18 May


Reduction in costs with early physiotherapy

  Early physiotherapy Late physiotherapy
Imaging £305 £521
GP visits £167 £265
Surgery/injections £657 £1,783
Total costs £2,033 £3,801