We read with interest the article published by Arnold et al
1
examining the effect of timing of physical therapy (PT) for acute low back pain on
health services utilization (HSU). Reducing overuse of imaging, opioids, injections,
and surgery for low back pain is an international priority.
2
That early access to PT could replace or reduce many of these services is not an
unreasonable proposition, and one that is worthy of rigorous scientific investigation.
However, we feel that by emphasizing observational studies over randomized controlled
trials in their synthesis of available literature, the authors have, in this case,
taken an approach that was suboptimal.To read this article in full you will need to make a payment
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References
- The effect of timing of physical therapy for acute low back pain on health services utilization: a systematic review.Arch Phys Med Rehabil. 2019; 100: 1324-1338
- Low back pain: call for action.Lancet. 2018; 391: 2384-2388
- Early physical therapy vs usual care in patients with recent-onset low back pain: a randomized clinical trial.JAMA. 2015; 314: 1459-1467
- Early access to physical therapy treatment for subacute low back pain in primary health care: a prospective randomized clinical trial.Clin J Pain. 2006; 22: 505-511
- Effectiveness and downstream healthcare utilization for patients that received early physical therapy versus usual care for low back pain: a randomized clinical trial.Spine (Phila Pa 1976). 2018; 43: 1313-1321
Article info
Footnotes
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
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Access this article on ScienceDirectLinked Article
- Re: Early Physical Therapy for Acute Low Back Pain May Not Reduce Health Services Utilization, Costs, and Opioid UseArchives of Physical Medicine and RehabilitationVol. 100Issue 7
- PreviewWe would like to thank the authors of the Letter to the Editor for their interest and insight into our review, “The Impact of Timing of Physical Therapy for Acute Low Back Pain on Health Services Utilization.”1 We agree that to make more definitive causal claims about the outcomes from the timing of physical therapy, randomized control trials (RCTs) are needed. The final version of the abstract will reflect a modification that removes causal claims. We believe that future research in this area should focus on using rigorous methodological designs that include randomization and observational studies that use large databases of medical records, claims, and representative national samples.
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