Immediate treatment by a physiotherapist, bypassing a waiting list, can reduce problems with recurring low back pain, according to a thesis from the University of Gothenburg, Sweden.

Many people suffer with low back pain, and most get better. However, those who suffer with long-term pain can find that their work, everyday, and leisure activities are limited to varying degrees. Given that long-term pain often requires extensive treatment, it is important that the pain be treated at an early stage, say the researchers.

"I wanted to find out whether patients’ low back pain could be alleviated in the long run if primary care clinics could offer examinations and treatment by a physiotherapist without any delay in the form of a doctor’s referral or waiting list," says Lena Nordeman, a registered physiotherapist and researcher at the Sahlgrenska Academy.

As part of her thesis, Nordeman conducted  a study in a same-day appointment model with the option of going straight to a physiotherapist, with or without a referral from a physician. The effect of receiving an examination and treatment within 48 hours was subsequently evaluated compared to being on a waiting list for 4 weeks before receiving the same treatment.

Some 60 patients with low back pain for 3 to 12 weeks participated in the study, which was carried out in primary health care in Södra Älvsborg, south-west Sweden.

"We saw that both groups improved after the treatment ended. The group that had been given early access to an examination and individualised treatment maintained their improvement after 6 months, while the group that had been held on a waiting list were more likely to suffer with recurring back pain," said Nordeman, who draws the conclusion that early examination and treatment by a physiotherapist as soon as a patient asks for care could be important for reducing low back pain in the long term.

Her thesis also included an investigation of 130 women who had suffered with low back pain for more than 3 months and who among others had undertaken a walk test. A follow-up after 2 years revealed that the walk test was a good predictor of both future ability to work and limitations in everyday activities.

It is recommended that patients with long-term widespread pain or fibromyalgia be given education and a physical exercise program to help alleviate their symptoms, according to the researchers. Nordeman’s thesis also looked at which patients benefit most from this treatment. Some 166 patients with widespread pain or fibromyalgia were randomly divided into two groups, the first of which was given a six-session education program and 20-week pool exercise program supervised by a physiotherapist, while the second was given just the education program.

"We saw that the group that received both the education and the physical exercise program showed the greatest improvement in perceived health, and that patients with moderate symptoms benefitted most from exercise," said Nordeman.

[Source: University of Gothenburg]