Physiotherapy added to GP care results in long-term improvements for sciatica

Abstract

In acute sciatica, does the addition of physiotherapy to general practitioner (GP) care improve patients’ global perceived effect of treatment? Randomised controlled trial with block randomisation and concealed allocation. The statistician was blinded to group allocation but participants, physiotherapists, and GPs were not. Eighty-six percent of participants were followed up at one year. Both per protocol and intention-to-treat analyses were performed. Community-based study involving 112 GPs and 33 physiotherapists in Rotterdam, The Netherlands. 135 adults with acute sciatica (lumbosacral radicular syndrome) were included. Those with a history of back surgery in the past 3 years or current indications for surgery were excluded. Participants in both groups were treated by their GP according to the Dutch College of General Practitioners’ 1996 clinical guideline for lumbosacral radicular syndrome. The intervention group additionally received advice, education, and exercise therapy from a physiotherapist. Participants in both groups received a maximum of nine individual consultations over a 6-week period. The primary outcome was Global Perceived Effect (GPE), measured on a 7-point scale ranging from 1 = completely recovered to 7 = vastly worsened. Results were dichotomised such that ‘completely recovered’ and ‘much improved’ were categorised as ‘improved’. Secondary outcomes assessed included: back and leg pain severity (11-point numerical rating scale), self-reported disability (0–24 Roland-Morris Disability questionnaire for sciatica), health status (Short-Form 36 and the Euroqol-5D) and fear of movement (Tampa scale for kinesiophobia). Outcomes were measured at 3, 6, 12, and 52 weeks after randomisation. At 12 weeks follow-up, 70% of the intervention group and 62% of the control group reported improvement (absolute risk reduction [ARR] 8%, 95% CI –4 to 20, number needed to treat [NNT] 12.) At 52 weeks follow-up, 79% of the intervention group and 56% of the control group reported improvement (ARR 23%, 95% CI 11 to 35, NNT 4.) The secondary outcomes did not differ between groups significantly. Sub-group analysis indicated that physiotherapy resulted in clinically and statistically significant treatment effects among those with higher disability (Roland-Morris Disability score ≥ 17 at baseline) at both 12 and 52 weeks. This study demonstrates that physiotherapy added to GP care for sciatica results in clinically worthwhile improvements in the long-term, particularly for those who present with more severe disability.