Management Strategies for Patients with Low Back Pain and Sciatica

描述（由申请人提供）：腰痛（LBP）是一种常见且昂贵的疾病。当伴有坐骨神经痛时，持续性残疾和未来侵入性治疗的风险增加。大多数患有LBP和坐骨神经痛的患者进入初级保健的医疗保健系统。最佳的初级保健管理目前尚不清楚，几乎没有数据可以帮助临床医生和告知患者常见选择的可能影响。实践指南一致认为，成像，脊柱注射和手术应该保留给症状在4-8周内没有减轻的患者，但这些程序的使用率正在迅速增加，部分原因是不确定性，可以为患者提供哪些选择进行初始治疗。物理治疗被认为是一种选择，在最初的管理期间，但使用不一致。目前尚不清楚LBP和坐骨神经痛患者的早期物理治疗可以预期什么，以及它可能对临床结果或未来医疗保健利用产生的任何长期影响。我们的研究团队已经进行了一系列的临床试验，以澄清证据，为患者提供最有效的物理治疗程序， LBP和坐骨神经痛，现在能够评估早期使用循证物理治疗是否可以降低未来残疾的风险，医疗保健利用率和成本。这项研究是一项随机试验，比较了新咨询的LBP伴坐骨神经痛患者的常规、基于指南的初始管理的有效性，有或没有添加早期物理治疗。具体目标是比较临床效果，成本（直接和间接），以及增加物理治疗的成本效益。所有患者将通过咨询、教育和药物治疗进行管理。一组还将接受6-8次物理治疗。结果将包括残疾、疼痛、心理困扰、医疗保健、利用率和1年内的费用。这项研究将允许检查的有效性和成本与使用早期物理治疗在初级保健急性腰痛和坐骨神经痛患者。这项研究的结果将提供必要的信息，以帮助临床医生，并告知患者他们的选择，初步管理这种常见的条件。

DESCRIPTION (provided by applicant): Low back pain (LBP) is a common and costly condition. When accompanied by sciatica, risks for persistent disability and future invasive treatments increase. Most patients with LBP and sciatica enter the healthcare system in primary care. Optimal primary care management is currently unclear and little data are available to assist clinicians and inform patients of the likely effects of common options. Practice guidelines agree that imaging, spinal injections and surgeries should be reserved for patients whose symptoms do not diminish within 4-8 weeks, yet utilization rates for these procedures are increasing rapidly, partly due to the uncertainty of what options may be offered to patients for initial treatment. Physical therapy is considered an option in the initial management period, but is used inconsistently. It is currently unclear what can be expected from early physical therapy for patients with LBP and sciatica, and what if any long-term effect it may have on clinical outcomes or future healthcare utilization. Our research team has conducted a series of clinical trials to clarify the evidence for the most effective physical therapy procedures for patients with LBP and sciatica, and is now in a position to evaluate if the use of early, evidence-based physical therapy can reduce the risk of future disability, healthcare utilization and costs. The proposed study is a randomized trial comparing the effectiveness of usual, guideline-based initial management of newly consulting patients with LBP with sciatica with or without the addition of early physical therapy. Specific aims are to compare the clinical effectiveness, costs (direct and indirect), and cost-effectiveness of the addition of physical therapy. All patients wil be managed with advice, education and medication. One group will also receive 6-8 sessions of physical therapy Outcomes will include measures of disability, pain, psychological distress, healthcare, utilization, and costs over 1 year. This study will permit an examination of the effectiveness and costs associated with the use of early physical therapy within primary care for patients with acute LBP and sciatica. The results of this study will provide needed information to assist clinicians and inform patients of their options for initial management of this common condition.