Early physical therapy (PT) resulted in statistically significant improvement in disability among 220 young adults with recent-onset low back pain (LBP), but the improvement was modest and did not achieve the minimum clinically important difference when compared with usual care. All study participants received education and the intervention group received early physical therapy (n=108) consisting of 4 sessions. Usual care (n=112) involved no additional interventions during the first 4 weeks. After 1-year follow-up (n=207), researchers found:

• Early PT showed improvement relative to usual care in disability after 3 months.

• A significant difference was found between groups for the Oswestry Disability Index (ODI) score, a score of disability, after 4 weeks (between group difference, -3.5) but not at 1-year follow-up (between group difference, -2.0).

• There was no improvement in pain intensity at 4-week, 3-month, or 1-year follow-up.

• The Pain Catastrophizing Scale (PCS) scores improved at 4 weeks and 3 months but not at 1-year follow-up.

Citation: Fritz JM, Magel JS, McFadden M, et al. Early physical therapy vs usual care in patients with recent-onset low back pain. JAMA. 2015;314(14)1459-1467. doi: 10.1001/jama.2015.11648.

Commentary: The main measure used here, the Oswestry Disability Index (ODI), is a 100-point scale, with higher scores representing more disability. A clinically significant difference is felt to be 6 points on the scale. The difference between the physical therapy group and the control group at 3 months was minimal, with both groups improving from approximately a score of 41 to a score of 6 and 9, respectively. This was a clinically insignificant 3-point difference between the groups. At 4 weeks the difference was 3.5 points and at 1 year there was no difference. There was no difference in pain scores at any point. This study confirms that the best intervention for individuals with musculoskeletal low-back pain without radiculopathy is reassurance to continue with usual activities with treatment for pain until the person improves. There is no significant benefit to either bed rest or physical therapy. —Neil Skolnik, MD