Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica : A Randomized Controlled Trial
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(4):50 Ann Intern Med . 2021 Jan;174(1):8-17.What this means for my practice?
Early referral to physical therapy for acute sciatica resulted in greater improvements in disability and self-reported treatment success compared to usual care, without increasing healthcare utilization. This suggests that primary care physicians should consider early physical therapy referral for patients with acute sciatica. However, the lack of blinding and inability to determine which physical therapy components were most effective are limitations to consider.
Study Summary
Two hundred twenty adults with acute sciatica of less than 90 days’ duration were randomized to receive either usual care (UC) (n=110) or early physical therapy (EPT) (n=110). The primary outcome was disability improvement measured by the Oswestry Disability Index (ODI) at 6 months. Secondary outcomes included pain intensity, patient-reported treatment success, healthcare utilization, and missed workdays, assessed at 4 weeks, 6 months, and 1 year. Overall, the study found that EPT led to greater improvement in disability compared to UC at 6 months and at 1 year . Patients in the EPT group were also more likely to report treatment success at 1 year. No significant differences were found in healthcare utilization or missed workdays. These findings suggest that early physical therapy referral improves disability and self-reported success in managing acute sciatica.
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