Physiotherapists and General Practitioners as first-line of management for acute low back pain: Which is better? A systematic review.
Significant acute low back pain (LBP) is experienced by at least 70% of adults in developing and developed countries at some point during their lifetime.LBP is a common cause leading to disability. There has been an increase in the need for consistency in the management of acute LBP across professions and at present there is no clear indication whether patients with acute LBP should consult a general practitioner or a physiotherapist.
The main objective of the review was to evaluate the effectiveness of physiotherapy primary care compared to general practitioner primary care in outcomes such as pain reduction and improvement of function, for adults with acute LBP.
A comprehensive search of keywords contained in the title and abstract, and the relevant MeSH headings and descriptor terms was performed on the following computerized bibliographic databases: PubMed, CINAHL and Sports Discus on EBSCOHost, Cochrane Library, Scirus, BioMed Central, PEDro, ScienceDirect, Proquest Medical Library, Ingenta Connect, ClinicalTrials.gov, PsycINFO, AMI, DARE, TRIP, Digital Dissertations, Current Content Connect, Current Controlled Trials, and Scopus, during November 2007 and January 2008. An update of the search was conducted in September 2009, prior to publication.
Papers were considered if they were randomized controlled trials focusing on the effectiveness of physiotherapy management compared to general practitioner management in reducing pain and improving function in acute LBP in adults.
Study design and quality were tabulated, and effect sizes, mean differences and associated 95% confidence intervals were calculated from studies which provided sufficient data, using Thalheimer's effect sizes spreadsheet and RevMan 5. All other data were presented in a narrative summary.
The comprehensive search identified six studies that satisfied the inclusion criteria. However, two studies were excluded as the one did not present subgroup data individually and a usable full report could not be retrieved for the other. Consequently, four studies were included in this review.
A firm conclusion as to whether physiotherapists or general practitioners are more effective in managing acute low back pain cannot be made from the results of this review. Further research into the most effective and most cost-effective treatments and referral pathways for acute LBP are therefore warranted.
1. Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Stellenbosch University, South Africa.
Linzette D
LD
Morris
Quinette A
QA
Louw