McAuley, J. H., Wand, B. M., Bird, C., & De Souza, L. H. (2005). Optimising physiotherapy care for acute low back pain – identifying non-responders to treatment. Musculoskeletal Physiotherapy Australia 14th Biennial Conference.
Recent evidence suggests that positive effects of physiotherapy for acute low back pain patients can be achieved if treatment is delivered early enough. However it is clear that not all patients treated with physiotherapy are likely to report equally positive outcomes from their treatment. The identification of clinical characteristics of those patients who do less well will help refine models of care for acute low back pain.
Aim: To identify non-responders to early active physiotherapy.
Method: A secondary analysis was conducted on the data from a recently published randomised controlled trial of early physiotherapy for acute low back pain. All patients were randomised into two groups: immediate physiotherapy or advice and wait list and completed a series of physical, psychological and pain measures at baseline and again at six weeks. Multivariate statistical analysis was conducted to identify which patient baseline characteristics were associated with unsuccessful outcomes at the six week follow up. Control group comparisons permitted only those relationships associated with the intervention to be described.
Results: Data analysis indicated that subgroups of patients who responded poorly to their physiotherapy treatment could be identified by a priori knowledge of their pain, mental health and physical function (p<0.05).
Conclusions: The results of the current analysis suggest that there are identifiable subgroups of patients who respond less well to physiotherapy treatment. Attention to these patient characteristics needs to be included in models of care for acute low back pain so that effects of therapy for all patients can be optimised.
back pain, physiotherapy, outcomes