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Physician Update – March 2022

The Results Are In!


One of the biggest daily challenges physicians face is the referral debate: Should I send this patient to a physical therapist or other specialist or continue to treat them myself? Would a referral really help with their condition?

The right path isn’t always clear. But in the case of acute sciatica, new research has finally provided an answer: An early referral to a physical therapist will, in fact, improve a patient’s long-term health outcomes.

Researchers discovered this by conducting a randomized controlled trial of 220 adults with sciatica. Half of the participants received usual care (one session of education), while the other half received one session of education and a referral for four weeks of physical therapy. After treatment, the researchers scored the patients on the Oswestry Disability Index (OSW) and measured their pain intensity, self-reported treatment success, health care use, and missed workdays.

The results were clear: The patients who received an early referral to a physical therapist had “greater improvement from baseline” in their OSW scores after one month, six months, and one year. They also had lower back-pain intensity at the one-year mark and were “more likely to self-report treatment success.”

Missed work days and health care use were comparable between the two groups. In short, an early referral to physical therapy reduced the patients’ disability. This trial came on the heels of a similar one of 135 patients in 2008. The 2008 trial found “there was a significant and clinically relevant difference (23%) [in the Global Perceived Effect (GPE)] between both
groups, in favour of the [physical therapy] intervention group” after one year, and noted that “PT care added to GP care seemed to be especially effective regarding GPE in the subgroup with patients reporting more severe disability at presentation.”

As a physical therapist myself, this outcome doesn’t surprise me. I’ve noted in past letters that clinical guidelines worldwide consistently recommend against prioritizing invasive or pharmacological treatments for lumbar or low-back pain (LBP), advising instead that patients stay active and seek education and exercise therapy for the best results. 1, 4 Sciatica affects roughly 40% of the population, according to Harvard Medical School, and as our country recovers from the omicron variant, you will likely see an uptick of sciatica patients in your office. While sciatica is typically associated with old age, obesity, and diabetes, prolonged periods of sitting — for example in a work-from-home or so-called “soft lockdown” setting, or simply due to winter weather — can also contribute to sciatica risk.

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Julian Manrique

Focus Physical Therapy

"We Help Adults Get Back To Their Normal Active Lifestyles Naturally...While Avoiding Medications, Injections, And Surgeries"