Effectiveness and Subsequent Healthcare Use Associated With Early Physical Therapy Access Compared With a Stepped Usual Care Approach for Treatment of Low Back Pain.
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Madigan Army Medical Center
- Enrollment
- 119
- Locations
- 1
- Primary Endpoint
- Modified Oswestry Disability Index
Study Overview
Brief Summary
The primary purpose of this study is to compare the effectiveness of two management strategies for patients with a recent onset of low back pain (LBP). One is based on usual care and the other is based on early access to physical therapy following a pragmatic treatment-based classification approach. The secondary purposes are to compare the subsequent healthcare utilization associated with two management strategies as well as to evaluate the importance of psychosocial factors on outcomes within both groups of treatment. The overall hypothesis guiding the study is that the additional initial treatment expense incurred by early implementation will result in superior short-term clinical effectiveness, and will be more cost-effective in the long-term due to reduced healthcare utilization. We will also explore the importance of psychosocial factors on outcomes within both treatment groups, which may provide insights for further improving treatment strategies.
Detailed Description
The specific aims of this study are the following:
- Compare the effectiveness of two primary care management strategies for patients with a recent onset of combat-related LBP. We hypothesize early physical therapy access for these Soldiers will result in greater improvements in function and quality of life over 1 year as compared to a stepped care strategy.
- Compare the subsequent healthcare utilization associated with two management strategies for patients with a recent onset combat-related LBP. We hypothesize early physical therapy access will result in decreased healthcare utilization over 1 year as compared to a stepped care strategy.
- Evaluate the importance of psychosocial factors on outcomes within both groups of treatment.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Outcomes Assessor)
Eligibility Criteria
- Ages
- 18 Years to 60 Years (Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Military personnel on active duty and eligible for healthcare at a military treatment facility
- •A primary complaint of low back pain defined as symptoms of pain and/or numbness between the 12th rib and buttocks with or without symptoms into the leg(s), which, in the opinion of the provider, are originating from tissues of the lumbar region.
- •Duration of current episode of low back pain < 90 days
- •Age 18 - 60 years (or emancipated minors on active duty)
- •Available for the following 4 weeks to complete a regimen of treatment
Exclusion Criteria
- •Oswestry Disability Index < 20%
- •History of receiving any medical care for this episode of low back pain within the last 3 months
- •Prior surgery to the thoraco-lumbar spine or pelvis
- •This episode of back pain is due to a traumatic fracture
- •Pending a medical or physical evaluation board or discharge process, pending any litigation related to the condition, or planning on getting out of the military within the next 9 months.
- •Any "red flags" that would indicate a potentially serious condition or other significant disease process. These could include but not limited to cauda equina syndrome, large or rapidly progressing neurological deficit, fracture, cancer, ankylosing spondylitis, or other systemic disease.
- •Current episode occurred because of a motor vehicle accident
- •Currently pregnant (or history of pregnancy in the previous 6 months)
Arms & Interventions
Usual Care (UC)
The usual care (UC) group will be managed with stepped care approach, receiving a screening exam, advice, education, activity limitation profile and medications if needed, but no early physical therapy.
Intervention: Usual Care (UC) (Procedure)
Early Physical Therapy (PT)
All subjects in this group will get usual care approach in addition to immediately receiving eight sessions of physical therapy based on a pragmatic treatment based classification system for treating low back pain.
Intervention: Early Physical Therapy (PT) (Procedure)
Outcomes
Primary Outcomes
Modified Oswestry Disability Index
Time Frame: 12 months
The Modified Oswestry Disability Questionnaire (OSW) is a 10-item condition-specific measure of functional status (pain and disability) for patients with low back pain (LBP). Each question has 6 possible answers (0 = worse, 5 = best). The raw score is doubled to provide a percent score from 0 to 100%; with 0 equaling no disability and 100% equalling the worst possible outcome. It measures pain-related disability. We used the modified version that replaces the sex life item with an employment/ homemaking item due to poor compliance with the former. The OSW is widely used in research on non-operative management of patients with LBP, with high levels of test-retest reliability among stable patients (ICC = 0.90), good construct validity, and responsiveness to change for patients with acute LBP. It has a minimum clinically important difference of 6 points.
Secondary Outcomes
- Numeric Pain Rating Scale (NPRS)(12 months)
- Global Rating of Change (GRC) of +3 or More (Minimum Clinically Important Change)(12 Months)