Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica : A Randomized Controlled Trial

Area of Science:

• Orthopedics
• Physical Therapy
• Primary Care Medicine

Background:

• Limited research exists on primary care management for acute sciatica, particularly regarding physical therapy referrals.
• Acute sciatica management often involves primary care, but optimal referral strategies are not well-defined.

Purpose of the Study:

• To determine if early referral to physical therapy (EPT) for acute sciatica leads to better outcomes than usual care (UC) alone.
• To evaluate the impact of EPT on disability, pain, and patient-reported success in acute sciatica patients.

Main Methods:

• A randomized controlled trial involving 220 adults with acute sciatica (duration < 90 days) was conducted.
• Participants received either UC (education) or EPT (education + 4 weeks of physical therapy including exercise and manual therapy).
• The primary outcome was the Oswestry Disability Index (OSW) score at 6 months, with secondary outcomes including pain, treatment success, healthcare use, and workdays missed.

Main Results:

• Early physical therapy significantly improved the primary outcome (OSW score) at 6 months compared to UC.
• Improvements favoring EPT were observed for OSW and pain intensity at 1 year.
• Patients receiving EPT reported higher treatment success rates after 1 year, with no significant differences in healthcare utilization or missed workdays.

Conclusions:

• Referral from primary care to physical therapy for recent-onset sciatica is effective in improving disability and other patient-reported outcomes.
• Early physical therapy represents a beneficial intervention for managing acute sciatica in a primary care setting.