Physical therapy referral improves outcomes of patients with sciatica

Referral of patients with recent-onset sciatica from primary care to physical therapy improves disability and other outcomes compared with usual care, a study has shown.

A total of 220 adults aged 18–60 years with sciatica of <90 days’ duration who were making an initial primary care consultation were randomized to early physical therapy (EPT; n=110) or usual care (n=110). The usual care group received one education session, while the EPT group received one education session and was then referred for 4 weeks of physical therapy, including exercise and manual therapy.

All participants received imaging and medication at the discretion of the primary care provider prior to enrolment. The Oswestry Disability Index (OSW) score after 6 months was the primary outcome. Secondary outcomes included pain intensity, patient-reported treatment success, healthcare use, and missed workdays.

The EPT group showed greater improvement from baseline to 6 months for the primary outcome (relative difference, –5.4 points, 95 percent confidence interval [CI], –9.4 to –1.3; p=0.009). After 4 weeks, EPT resulted in more favourable OSW and secondary outcomes. After 1 year, between-group differences still favoured EPT for the OSW (relative difference, –4.8 points, 95 percent CI, –8.9 to –0.7) and back pain intensity (relative difference, –1.0 points, 95 percent CI, –1.6 to –0.4).

Patients in the EPT group were more likely to self-report treatment success after 1 year than those in the usual care group (45.2 percent vs 27.6 percent; relative risk, 1.6, 95 percent CI, 1.1–2.4). No significant between-group differences were seen in healthcare use or missed workdays.

The study was limited by the unblinded patients and providers. In addition, specific physical therapy interventions responsible for effects could not be determined.