Doctor's Resources

Downloads

	APA Position Statement on Exercise Prescription 20051023.pdf	(93 KB)
	APA Position Statement on LBP 20051023.pdf	(212 KB)
	Falls & Balance-BPPV.pdf	(156 KB)
	Falls prevention.pdf	(27 KB)
	Physios don't want to be doctors!.pdf	(149 KB)
	_vti_cnf.log	(0 KB)

Click below for more useful information!

• What Is The McKenzie Method?
• Exercise- How can it help my patients?
• Effective treatment for Plantar Fasciitis

EVIDENCE FOR PHYSIOTHERAPY MANAGEMENT IN LOW BACK PAIN

Low back pain (LBP), affects 80% of the population at some time in their lives. (Deyo 1983, Frymoyer 1988).

In determining effective management for low back pain, it is necessary to review the scientific evidence available on the efficacy of the various management regimens.

Physiotherapy management regimens include passive mobilisation of the spine and spinal soft tissues, electrotherapy modalities, thermal modalities and specific exercises to correct and control identified spinal movement disorders. There are specific exercises, which require the skills of a physiotherapist to analyse dysfunctional movement patterns and prescribe the appropriate movements at the appropriate time in the context of the pathology, state of tissue repair healing and patient’s pain response.

Physiotherapists are trained in the systematic assessment, diagnostic decision-making and management of patients with low back pain arising from neuromusculoskeletal disorders. Physiotherapy involves not only “manipulation” but also manual handling with passive examination and treatment techniques, therapeutic exercise and education about posture and safe, beneficial activity modification. Physiotherapists play leading clinical, educational and research roles in the delivery of healthcare to the community.

Evidence For The Role Of Physiotherapy In The Management Of Acute LBP

1. Shekelle et al (1992) concluded that manipulation is effective in the short term management of low back pain. This finding was also supported by a USA systematic review completed by the Agency for Health Care policy and Research (AHCPR), which defined manipulation as manual loading of the spine using short or long leverage methods. Their findings were that manipulation was shown to be superior to the comparison regimens of traction, massage, epidural injections and short waves diathermy.
2. DiFabio (1992) concluded that there is clear evidence that manual therapy, particularly manipulation is effective in the immediate or short term reduction of symptoms in the acute low back pain patient. He also concluded that manipulation produces a statistically significant reduction in pain levels (Hoehler et al 1981, Glover et al 1974) and increases in painfree range of motion (Evans et al 1982).
3. Linton et al (1993) showed that encouraging early activation and normal activity leads to a more rapid symptomatic recovery than “usual medical care”. This also helps to reduce the risk of developing chronic low back pain.
4. There is evidence that McKenzie therapy is effective in the treatment of acute low back pain. The McKenzie therapy method is a patient-orientated treatment regimen. Physiotherapists assess their patients and prescribe a set of exercises according to their symptomatic response. Patients are encouraged to adopt antalgic postures regularly and avoid provocative postures and movements.
5. Physiotherapists are highly accurate in determining whether patients’ symptoms are discogenic in nature, when assessing according to the McKenzie regimen. The accuracy of physiotherapists in determining this was higher than MRI. (Donelson et al 1997).   
 

Conclusion:

There is evidence to support the role of physiotherapy - specifically, manual therapy, specific exercise and education - in the treatment of low back pain.

Equally, interventions such as the application of heat, shortwave and massage alone, have insufficient evidence to support their effectiveness at present and are not recommended as a first choice of treatment.

Evid ence For The Role Of Physiotherapy In The Management Of Sub-Acute LBP

1. Lindstrom et al (1992) compared a graded activity program supervised by a physiotherapist compared to rest and medication. The physiotherapy group had less sick leave than the comparison group.
2. Koes et al (1992) did a randomised controlled trial of 256 subjects, with 3, 6 and 12 months follow-up. Manual physiotherapy combined with appropriate exercise and education provided better results than rest and medication, decreasing the severity of the patients’ complaints and having a higher global perceived effect.
3. In one study, patients in the intervention group (n= 463) were educated to remove the fear associated with movement. The control group (n= 512) were not. At 6 month follow up, 30% of those in the intervention group were on sick leave compared with 60% in the control group. (Indahl et al 1995).

Conclusion:

A combination of manipulative physiotherapy, early activation and supervised exercises provided by a physiotherapist support the role of physiotherapy in the management of sub-acute low back pain. Moreover, these interventions have resulted in less sick leave and better pain relief than “usual medical care”. Activity is better than inactivity or rest in the management of sub-acute low back pain.

Evidence For The Role Of Physiotherapy In The Management Of Chronic LBP

1. Exercise therapy provided by a physiotherapist is effective for management of chronic LBP with improvements in pain and functional levels. (Waddell et al & Maher et al, (1996)).
2. Exercise programs that are designed and supervised by physiotherapists reduce absenteeism and hasten return to work rates. (Edwards et al 1992, Kellet et al 1991, Gundewall et al 1993, Mitchell et al 1998).

Conclusion:

Exercise programs supervised by physiotherapists are more effective in the management of LBP than other types of intervention.

Cost-Effectiveness Of Physiotherapy Management Of LBP

REFERENCES