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The Physio Files

May 2004 Physio Files Index

Case Study
New Developments

Published Date : 01:43PM 19 Sep 2007

Does Early Physiotherapy Intervention Equate To Better Outcomes

In the last decade, physiotherapists have become increasingly involved in the management of musculoskeletal injuries, both in the sporting and general population. However, even though the demand for services has increased it is still not uncommon for people to delay seeking physiotherapy for some time after the initial onset of their symptoms. This may be due to a limited awareness of the benefits of early intervention in some populations and even in the medical fraternity. Medical practitioners have a vital role to play in ensuring patients are referred for physiotherapy early and appropriately. Many studies have been conducted recently to examine the effect of early physiotherapy intervention.

Most research investigates the benefits of early intervention in the low back pain population. This is reasonable considering 70-80% of the general population will experience low back pain at some stage in their lives. It is also the number one cause of disability in the under 45 years old population.1% of the working age population is either totally or permanently disabled due to chronic low back pain. (Gatchel et al, 2003). Hence, chronic low back pain is a serious problem resulting in immeasurable suffering, work loss and expense to the community (eg; medical care, surgical care, workers compensation etc).

Gatchel et al (2003) investigated the treatment and cost effectiveness of early intervention for acute low back pain patients. The result of the study clearly demonstrated that patients who were managed earlier by their doctors and physiotherapists had better outcomes. They have either nil or less recurring episodes and the return to work rate was higher. Not only does early intervention prevent the development of chronic low back pain, it also reduces wage-loss and health care costs. An important note was made that acute low back pain has less complications than chronic low back pain. Hence, it is important to manage acute episodes properly to prevent the development of chronicity. Physiotherapy intervention was also shown to have positive long-term benefits.

The benefits of early intervention have also been supported by Lusted, M (1993), who studied the predicting factors of return to work after rehabilitation following back injury. The results indicated that the success of rehabilitation is influenced by the age of the worker and the length of time between injury and referral. The author suggested that many personal factors will have less influence if the worker is referred early for physiotherapy rehabilitation. The study also confirmed that early intervention is crucial to prevent the development of chronicity, which is associated not only with physical, but also psychosocial barriers (eg illness behaviour), which in turn affects the benefits they can gain from physiotherapy.

Patients who had treatment at an earlier point following injury responded better and had better outcomes. Woods et al (2000) administered similar interventions in two patient groups subacute (less than six months post injury) and chronic. The results confirmed previous findings that chronic patients benefit less from physiotherapy because they have more inhibition in their neuromuscular task performance and more sensitive to pain and have more psychosocial barriers.

Ehrmann et al (1996), who investigated the relationship between physician referral and rate of return to work in a cohort of workers compensatedfor low back pain found that patients who were referred earlier to physiotherapy return to work sooner than the later referrals. This finding is supported by Alday et al (1997) who conducted a similar study and reported that the successful return to work for patients who had early intervention is up to 87% and even for those who did not return to the same work, the successful outcome rate is 98%. Hence both studies highlighted yet again the importance of early referral and early management.

The findings of these recent studies suggest that early physiotherapy intervention does result in better outcomes and that early referral by physicians to physiotherapists will reduce lost work time, reduce pain and regain function at a faster rate than delayed referral. This will also reduce health expense for the general community.

References for this article can be supplied on request - admin@empc.com.au.
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