How is Low Back Pain Managed?: Retrospective study of the first 200 patients with low back pain referred to a newly established community-based physiotherapy department

Abstract

Summary Background and Purpose Little is known about the treatment modalities used by UK physiotherapists in their management of low back pain (LBP). This paper describes a retrospective study of the first 200 patients referred to a newly established musculoskeletal primary care physiotherapy service. The purpose was to ascertain types and numbers of treatments, outcomes on discharge and whether the outcomes were affected by chronicity of the back pain. Methods The available physiotherapy notes for the first 200 patients referred to the department with LBP were identified and retrieved. Each set of notes was analysed and a common set of data was collected. Any ambiguous entries in the notes were discussed with the physiotherapist concerned in order to clarify the data. Physiotherapists were also interviewed to elicit their views about the value of electrical treatments. Results and Conclusions Two hundred patients were referred, of whom 20 (10%) failed to attend the department. Of those who completed their treatment 86% achieved satisfactory outcomes. Median number of treatments per case for this group was six, with a mean time per case of 141 minutes. Acute cases (less than six weeks duration) did better than less acute cases although the difference was not statistically significant. Electrical treatments were often used but to a smaller extent than ‘physical' treatments. The general approach included patient education, encouragement to increase activity and accept responsibility for their condition, and use of physical treatments (eg McKenzie exercises). Manipulation was used in less than 5% of cases. Patients who received early intervention (sometimes with a visit to their home) for severe, acute back pain, had 50% fewer treatment episodes. Reasons for non-attendance are discussed.