A Prospective Observational Study of Emergency Department-Initiated Physical Therapy for Acute Low Back Pain

Howard S. Kim, Jody D. Ciolino, Nicola Lancki, Kyle J. Strickland, Daniel Pinto, Christine Stankiewicz, D. Mark Courtney, Bruce L. Lambert, Danielle M. McCarthy

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: Low back pain accounts for nearly 4 million emergency department (ED) visits annually and is a significant source of disability. Physical therapy has been suggested as a potentially effective nonopioid treatment for low back pain; however, no studies to our knowledge have yet evaluated the emerging resource of ED-initiated physical therapy. The study objective was to compare patient-reported outcomes in patients receiving ED-initiated physical therapy and patients receiving usual care for acute low back pain. Methods: This was a prospective observational study of ED patients receiving either physical therapy or usual care for acute low back pain from May 1, 2018, to May 24, 2019, at a single academic ED (>91,000 annual visits). The primary outcome was pain-related functioning, assessed with Oswestry Disability Index (ODI) and Patient-Reported Outcomes Measurement Information System pain interference (PROMIS-PI) scores. The secondary outcome was use of high-risk medications (opioids, benzodiazepines, and skeletal muscle relaxants). Outcomes were compared over 3 months using adjusted linear mixed and generalized estimating equation models. Results: For 101 participants (43 receiving ED-initiated physical therapy and 58 receiving usual care), the median age was 40.5 years and 59% were women. Baseline outcome scores in the ED-initiated physical therapy group were higher than those in the usual care group (ODI = 51.1 vs 36.0; PROMIS-PI = 67.6 vs 62.7). Patients receiving ED-initiated physical therapy had greater improvements in both ODI and PROMIS-PI scores at the 3-month follow-up (ODI =-14.4 [95% CI =-23.0 to-5.7]; PROMIS-PI =-5.1 [95% CI =-9.9 to-0.4]) and lower use of high-risk medications (odds ratio = 0.05 [95% CI = 0.01 to 0.58]). Conclusion: In this single-center observational study, ED-initiated physical therapy for acute low back pain was associated with improvements in functioning and lower use of high-risk medications compared with usual care; the causality of these relationships remains to be explored. Impact: ED-initiated physical therapy is a promising therapy for acute low back pain that may reduce reliance on high-risk medications while improving patient-reported outcomes. Lay Summary: Emergency department-initiated physical therapy for low back pain was associated with greater improvement in functioning and lower use of high-risk medications over 3 months.

Original languageEnglish (US)
Article numberpzaa219
JournalPhysical Therapy
Volume101
Issue number3
DOIs
StatePublished - Mar 1 2021
Externally publishedYes

Keywords

  • Acute Care
  • Acute Pain
  • Analgesics
  • Back Pain
  • Emergency Care

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation

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