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Seeing a PT may lead to lower costs and less medical treatment



Spinal disorders are very common and expensive


Musculoskeletal disorders are injuries or pain in structures like ligaments, joints, and tendons throughout the body. They are one of the biggest health care problems affecting middle-aged Americans because they are extremely prevalent and expensive to treat. Of all musculoskeletal disorders, spinal disorders like low back pain account for the majority of costs and disabilities that people experience. This is mainly due to an increase in imaging studies like MRIs and CT scans, steroid injections, and spinal surgeries. As a result, there is a need for a better approach to reduce costs and improve the outcomes for patients.



Doctors may not refer patients to physical therapy for up to six weeks


Physical therapy is commonly prescribed as an effective treatment for patients with spinal disorders and other musculoskeletal disorders. The timing of when a patient is referred to physical therapy, and when it begins, can have a significant effect on the results they experience and the costs of treatment. Currently, guidelines recommend that doctors should delay referring patients with back pain to physical therapy for up to six weeks. Despite this, some studies suggest that starting physical therapy earlier-within 1-4 weeks-could lead to better outcomes and reduce the risk for developing long-lasting (chronic) pain and disability. Since these two approaches conflict with each other, more research is needed to determine how long a patient should wait before seeing a physical therapist. Therefore, a systematic review was conducted, which is a high-quality, comprehensive review on all the available studies on the timing of physical therapy for musculoskeletal disorders.



A total of 14 studies are used for the review


Researchers conducting the review searched through four major medical databases for studies that were relevant to the topic. In order to be selected for the systematic review, each study had to include data on physical therapy used for a musculoskeletal disorder, with one group using physical therapy early and the other using it later. A total of 3,135 studies were screened, and 14 of these fit the necessary criteria and were used for the review. These studies ranged in size and in quality, with the smallest study including 280 participants and the largest including 431,195 participants. The findings of all of these studies were then analyzed with the goal of determining if it was more beneficial to begin physical therapy earlier.



Some patients may benefit from seeing a physical therapist early


Although the review was supposed to cover a number of different musculoskeletal disorders, all the studies that were selected focused on spinal pain. Overall, there was evidence that starting physical therapy early (within four weeks) was associated with lower costs for the patient when compared to delaying treatment. This was likely due to the fact that fewer tests and interventions- like injections and surgery-were used when patients began treatment sooner. Those types of interventions may be recommended when patients hold off on treatment and see a doctor before a physical therapist. Unfortunately, the quality of the studies used in this systematic review was not very high, and additional studies are needed to investigate this topic in greater detail. Nonetheless, this review suggests that there is no risk of starting physical therapy within four weeks after low back pain is first noticed, and it may actually save patients money. Patients with low back pain and other spinal disorders should therefore consider seeing a physical therapist sooner rather than later for their condition.



-As reported in the February '16 issue of the Journal of Orthopaedic & Sports Physical Therapy
June 7, 2017