Does early physical therapy intervention reduce opioid burden and improve functionality in the management of chronic lower back pain?

Martin, Shedrick; Tallian, Kimberly; Nguyen, Victoria T; Dyke, Jason van; Sikand, Harminder

doi:10.9740/mhc.2020.07.215

Cited by 8 publications

(6 citation statements)

References 31 publications

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“…There is increasing evidence that in LBP patients, exercise alone or exercise in combination with education programs can reduce the risk of a future episode of LBP as well as future LBP intensity [ 25 , 26 ]. Additionally, a recent study showed that early physiotherapy significantly improves functionality and reduces pain in patients with chronic LBP [ 15 ], highlighting the importance of physiotherapy in the initial treatment of LBP. As our results show changes in volume and degeneration of lumbar and trunk musculature of LSTV patients, which may be caused by or may cause the development of LBP, exercise and physiotherapy need to be considered important strategies in pain prevention.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that atrophy of paraspinal muscles may lead to altered thoracic kyphosis, lumbar lordosis, and sacralvertebral angles both in adults with and without degenerative spinal disease [12][13][14]. Due to this important role trunk and lumbar muscles play in spinal integrity and pain development, physiotherapy has been shown to significantly improve functionality and positively alter the course of LBP [15].…”

Section: Introductionmentioning

confidence: 99%

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Musculature adaption in patients with lumbosacral transitional vertebrae: a matched-pair analysis of 46 patients

et al. 2021

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Objective Even though lumbosacral transitional vertebrae (LSTV) are one of the most common congenital anomalies of the spine, their effect on surrounding soft tissues is not well-studied. We therefore aimed at analyzing the association between LSTV and changes in volume, mass, symmetry, and degeneration of lumbar and trunk muscles. Materials and methods Abdomen–pelvis CT scans were analyzed in patients with LSTV and a matched control group. LSTV were classified according to the Castellvi classification. Muscles were segmented from the remaining soft tissue and their cross-sectional area and volume were examined at five defined levels. Threshold segmentation was used to differentiate between muscle fibers and fat tissue. Matched pairs were compared using Wilcoxon rank sum tests. For comparison of categorical data, chi-squared tests were performed and for associations between the degree of fusion and muscle size and degeneration, Spearman’s correlation coefficients were calculated. Inter- and intrarater reliabilities were evaluated by computing intraclass correlation coefficients. Results Forty-six patients with LSTV and 46 controls were included. Muscle volume of the paraspinal and trunk muscles was significantly lower (707.0 cm3 vs. 809.7 cm3, p < 0.001) and fatty muscle changes were significantly increased in all but the caudal paravertebral muscles of LSTV patients (M. psoas p < 0.04, M. quadratus lumborum p < 0.001, paravertebral muscles p = 0.011, M. rectus abdominis p < 0.001, M. obliquus abdominis p < 0.001). Correlations between the degree of Castellvi classification and muscle volume were significant (p = 0.001). Conclusion LSTV are associated with a reduction in muscle volume and an increase in muscle degeneration of both lumbar and trunk muscles.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Musculature adaption in patients with lumbosacral transitional vertebrae: a matched-pair analysis of 46 patients

et al. 2021

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“…Individuals with LBP were at significant risk for physical and mental health deterioration, due to the lack of clinical and self-management resources and pandemic-related stressors. 17 - 19 A large proportion of patients with LBP can be managed conservatively, 13 do not require imaging, 13 , 20 will have a normal neurological exam, 21 , 22 and benefit from a personalized home exercise program with education, guidance, and strategies for self-management. 22 , 23 This evidence supported the potential to utilize virtual care (VC) to assess and manage this patient population, when in-person assessment and management was very limited.…”

Section: Introduction/objectivesmentioning

confidence: 99%

A Model to Implement Standardized Virtual Care for Low Back Pain Amongst a Large Network of Providers in Urban and Rural Settings

Correale

Soever

Rampersaud

2022

J Prim Care Community Health

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Prior to the COVID-19 pandemic, virtual care (VC) was not routinely offered for assessment of low back pain (LBP), a highly prevalent, disabling condition. COVID-19 related healthcare closures resulted in a rapid backlog of patients referred to a provincial interprofessional LBP program. Without management, these patients were at high risk of experiencing untoward outcomes. Virtual care became a logical option. However, many clinicians lacked experience and confidence with LBP virtual care (LBP-VC); and either were unfamiliar with, or did not have access to, requisite technology. Multi-stakeholder engagement was utilized to understand barriers, identify enablers, and ultimately promote VC for LBP. As a result of the multi-stakeholder engagement, the concept of a toolkit for LBP-VC, including clinical resources and guidelines, emerged. The toolkit contains preparatory steps for VC and a standardized approach to virtual LBP assessment. Key steps in the toolkit have potential applicability to other musculoskeletal populations.

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“…The prevalence of analgesic intake for CSP varies across the literature, with some studies demonstrating very high levels (80%-100%) [ 31 , 69 ], while others report values in line with this study [ 26 ]. PT can contribute to a reduction in analgesic intake [ 70 , 71 ]. In this study, the low proportion of patients receiving pharmacological treatment at baseline (DGPT: 2/41, 4.9% and CG: 7/41, 17.1%) limited the statistical assessment of this aspect.…”

Section: Discussionmentioning

confidence: 99%

Comparing Digital to Conventional Physical Therapy for Chronic Shoulder Pain: Randomized Controlled Trial

Pak¹,

Janela²,

Freitas³

et al. 2023

J Med Internet Res

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Background Chronic shoulder pain (CSP) is a common condition with various etiologies, including rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. It is associated with substantial disability and psychological distress, resulting in poor productivity and quality of life. Physical therapy constitutes the mainstay treatment for CSP, but several barriers exist in accessing care. In recent years, telerehabilitation has gained momentum as a potential solution to overcome such barriers. It has shown numerous benefits, including improving access and convenience, promoting patient adherence, and reducing costs. However, to date, no previous randomized controlled trial has compared fully remote digital physical therapy to in-person rehabilitation for nonoperative CSP. Objective The aim of this study is to compare clinical outcomes between digital physical therapy and conventional in-person physical therapy in patients with CSP. Methods We conducted a single-center, parallel-group, randomized controlled trial involving 82 patients with CSP referred for outpatient physical therapy. Participants were randomized into digital or conventional physical therapy (8-week interventions). The digital intervention consisted of home exercise, education, and cognitive behavioral therapy (CBT), using a device with movement digitalization for biofeedback and asynchronous physical therapist monitoring through a cloud-based portal. The conventional group received in-person physical therapy, including exercises, manual therapy, education, and CBT. The primary outcome was the change (baseline to 8 weeks) in function and symptoms using the short-form of Disabilities of the Arm, Shoulder, and Hand questionnaire. Secondary outcome measures included self-reported pain, surgery intent, analgesic intake, mental health, engagement, and satisfaction. All questionnaires were delivered electronically. Results A total of 90 participants were randomized into digital or conventional physical therapy, with 82 receiving the allocated intervention. Both groups experienced significant improvements in function measured by the short-form of the Disabilities of the Arm, Shoulder, and Hand questionnaire, with no differences between groups (–1.8, 95% CI –13.5 to 9.8; P=.75). For secondary outcomes, no differences were observed in surgery intent, analgesic intake, and mental health or worst pain. Higher reductions were observed in average and least pain in the conventional group, which, given the small effect sizes (least pain 0.15 and average pain 0.16), are unlikely to be clinically meaningful. High adherence and satisfaction were observed in both groups, with no adverse events. Conclusions This study shows that fully remote digital programs can be viable care delivery models for CSP given their scalability and effectiveness, assessed through comparison with high-dosage in-person rehabilitation. Trial Registration ClinicalTrials.gov (NCT04636528); https://clinicaltrials.gov/study/NCT04636528

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Does early physical therapy intervention reduce opioid burden and improve functionality in the management of chronic lower back pain?

Cited by 8 publications

References 31 publications

Musculature adaption in patients with lumbosacral transitional vertebrae: a matched-pair analysis of 46 patients

Musculature adaption in patients with lumbosacral transitional vertebrae: a matched-pair analysis of 46 patients

A Model to Implement Standardized Virtual Care for Low Back Pain Amongst a Large Network of Providers in Urban and Rural Settings

Comparing Digital to Conventional Physical Therapy for Chronic Shoulder Pain: Randomized Controlled Trial

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