Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
Spine (Phila Pa 1976). 2012 Apr 20;37(9):775-82. doi: 10.1097/BRS.0b013e3181d79a09.
Retrospective cohort study.
To evaluate the relationship between early physical therapy (PT) for acute low back pain and subsequent use of lumbosacral injections, lumbar surgery, and frequent physician office visits for low back pain.
Wide practice variations exist in the treatment of acute low back pain. PT has been advocated as an effective treatment in this setting although disagreement exists regarding its purported benefits.
A national 20% sample of the Centers for Medicare and Medicaid Services physician outpatient billing claims was analyzed. Patients were selected who received treatment for low back pain between 2003 and 2004 (n = 439,195). To exclude chronic low back conditions, patients were excluded if they had a prior visit for back pain, lumbosacral injection, or lumbar surgery within the previous year. Main outcome measures were rates of lumbar surgery, lumbosacral injections, and frequent physician office visits for low back pain during the following year.
Based on logistic regression analysis, the adjusted odds ratio for undergoing surgery in the group of enrollees that received PT in the acute phase (<4 weeks) compared to those receiving PT in the chronic phase (>3 months) was 0.38 (95% confidence interval [CI], 0.360.41), adjusting for age, sex, diagnosis, treating physician specialty, and comorbidity. The adjusted odds ratio for receiving a lumbosacral injection in the group receiving PT in the acute phase was 0.46 (95% CI, 0.44-0.49), and the adjusted odds ratio for frequent physician office usage in the group receiving PT in the acute phase was 0.47 (95% CI, 0.44-0.50).
There was a lower risk of subsequent medical service usage among patients who received PT early after an episode of acute low back pain relative to those who received PT at later times. Medical specialty variations exist regarding early use of PT, with potential underutilization among generalist specialties.
回顾性队列研究。
评估急性腰痛患者早期接受物理治疗（PT）与随后接受腰骶部注射、腰椎手术以及因腰痛频繁就诊于医生办公室之间的关系。
急性腰痛的治疗方法存在广泛的实践差异。尽管对其所谓的益处存在分歧，但 PT 已被提倡作为该环境下的有效治疗方法。
分析了医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）医生门诊计费索赔的全国 20%样本。选择了在 2003 年至 2004 年期间接受腰痛治疗的患者（n=439195）。为了排除慢性腰痛情况，将在之前一年有过腰痛就诊、腰骶部注射或腰椎手术的患者排除在外。主要观察指标是在接下来的一年中接受腰椎手术、腰骶部注射和因腰痛频繁就诊于医生办公室的比率。
基于逻辑回归分析，与接受慢性期（>3 个月）PT 的患者相比，在急性期（<4 周）接受 PT 的患者接受手术的调整后优势比为 0.38（95%置信区间[CI]，0.360.41），调整因素包括年龄、性别、诊断、治疗医生专业和合并症。在急性期接受 PT 的患者中接受腰骶部注射的调整后优势比为 0.46（95%CI，0.44-0.49），在急性期接受 PT 的患者中因腰痛频繁就诊于医生办公室的调整后优势比为 0.47（95%CI，0.44-0.50）。
与接受晚期 PT 的患者相比，在急性腰痛发作后早期接受 PT 的患者随后接受医疗服务的风险较低。在早期使用 PT 方面，不同医疗专业存在差异，普通科专业可能存在潜在的利用不足。
