- This topic has 5 replies, 6 voices, and was last updated 6 years, 8 months ago by .
-
Posts
-
-
-
I believe that this article is useful even in the US because the prevalence of low back pain is so predominant. Additionally, CPGs are great tools in helping to promote high quality care as well as reduce the amount of inappropriate variations of treatments among medical providers. This particular article stated that the use of CPGs could help reduce the number of unnecessary referrals to spine surgeons. If there is a reliable cluster of non-operative CPGs for LBP it will allow for patients to seek help without seeing an MD prior to treatment, which could expedite this process and allow for faster relief. During this study they were finding that patients were not as compliant with their non-operative exercise routines as needed to be in order to have an accurate measure of the efficacy in this CPG. I agree with the article and stress that as physical therapists it is our duty to promote therapeutic treatments such as exercise to help treat the cause of the pain earlier and avoid the wait times associated with a consult to a spine surgeon.
-
I do think this study applies to the US population. It wouldn’t surprise me if the same study design conducted in the US came up with similar statistics in terms of the percentage of patient prescribed medication and not necessarily being referred to PT before a spinal surgeon. I think we probably need to improve how we sell or market our skill set if we want to become the first choice in treating low back pain. Forming relationships with primary care doctors and making them aware of the research, or demonstrating positive outcomes with specific patients whom they refer is one possible way of helping to make physical therapy their go to instead of referring to a surgeon.
-
I agree in thinking this study is applicable to the US, and specifically my patient population here in Woodstock. We have a large population of older individuals with LBP and chronic pain that is often managed with opioids. I thought their concern about the prescription of opioids as conservative management and the potential side effects is something we need to be very aware of as physical therapists. AJ had me read an interesting article on patterns and predictors of persistent opioid use following TKA/THA (attached), that I also think is relevant when considering those with chronic pain conditions. I think the sooner we see these people, whether it be those with LBP or knee/hip OA, the sooner we can start to positively influence these people’s pain and function without the use of potentially dangerous and harmful medications (or surgery). I also think it is part of our responsibility as PTs to advocate for our profession and our role in conservative management of those with chronic pain conditions prior to potential surgical intervention. This study found that those who participated in the recommended levels of physical activity had lower ODI and pain scores than those who didn’t, which is something that our patients need to be aware of and something we can use as an educational “nugget” during our treatment.
-
I agree with everything that you all have stated and I think that Katie’s article is a good supplement to the discussion. I do not see any barriers to extrapolating the results of this study to a population in the United States. I think the onus is on us as physical therapists to educate primary care physicians in our area about the research regarding conservative management of LBP vs surgery. In medical school, students usually get no more than two weeks of education on orthopedics. I think it is natural for MDs to refer their LBP patients to spine surgeons, because that is more of a known quantity for them. If more physical therapists made an effort to get to know the PCPs in their area, I feel that we could begin to sway a lot of these referrals in our direction. I would imagine that you have a better chance to convince a patient that spinal surgery should not be the first option if a spinal surgeon has not already told them that it is their only option.
-
I agree with Justin that PTs need to be better and forming relationships with MDs in the area to advocate for therapy/conservative care first. In my previous clinic, we had a more elderly patient population, and many with chronic LBP. Often times they would come into the clinic having already met with the spinal surgeon (and often given opioids). I think a big step towards impacting the findings of this study can be made in making sure that across the board we are all performing comprehensive assessments, educating, and listening to our patients. It takes trust in the health care provider and buy-in to the program for us to make a difference. We are lucky enough to be able to spend more time with our patients then the average primary care doc, and should take advantage of that. I thought the article Katie posted was very interesting, as well as a great educational tool. The statistics are hard to believe, especially for those who used opioids prior to surgery.
-
- You must be logged in to reply to this topic.