Integrating physiotherapy into the emergency department for acute low back spasm: a retrospective comparative study

This study aimed to compare the short-term clinical and economic outcomes of physiotherapy, pharmacological therapy, and combined management in patients presenting to the emergency department (ED) with acute mechanical low back spasm.

A retrospective analysis was conducted on 150 adults aged 18 to 65 years who presented to the ED between January 2024 and January 2025. Patients were retrospectively stratified according to the treatment received during routine emergency care into physiotherapy, pharmacological therapy, or combined therapy groups (n = 50 each). Pain intensity and functional activity were assessed at baseline (pre-treatment) and post-treatment at ED discharge, and direct, short-term costs related to ED care were calculated.

All treatment groups demonstrated significant reductions in pain intensity after intervention (within-group p < .001). The combined therapy group showed the greatest pain reduction (ΔVAS -5.80 ± 1.42), compared with physiotherapy (-3.80 ± 1.70) and pharmacological therapy (-3.30 ± 1.84) (between-group p < .001), with a large effect size (ε² = 0.31). Functional activity improved significantly in all groups (p < .001), with no significant difference between treatment modalities (p = .843). Patient-reported satisfaction scores differed significantly among groups and were highest in the combined therapy group (p < .001). Total treatment cost varied significantly between groups (p < .001), with pharmacological therapy being the least costly option.

Combined physiotherapy and pharmacological treatment was associated with superior short-term pain relief and higher patient-reported satisfaction compared with either approach alone in patients presenting to the ED with acute low back spasm. Despite higher immediate costs, these findings support the integration of physiotherapy into emergency care to improve short-term, patient-centered outcomes. Further prospective and cost-effectiveness studies are warranted.

ClinicalTrials.gov Identifier: NCT06987656.