Management Strategies for Patients with Low Back Pain and Sciatica

描述(由申请人提供)：下腰痛(LBP)是一种常见且代价高昂的疾病。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。大多数患有腰痛和坐骨神经痛的患者进入初级保健的医疗系统。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并告知患者常见选择的可能效果。实践指南一致认为，成像、脊柱注射和手术应保留给症状在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，部分原因是最初治疗可能向患者提供哪些选择的不确定性。理疗在最初的管理阶段被认为是一种选择，但使用起来并不一致。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到什么，以及它可能对临床结果或未来的医疗保健利用产生的长期影响。我们的研究团队已经进行了一系列临床试验，以澄清对患有慢性阻塞性肺疾病的患者最有效的物理治疗程序的证据 LBP和坐骨神经痛，现在能够评估早期、循证物理疗法的使用是否可以降低未来残疾的风险、医疗保健利用率和成本。这项拟议的研究是一项随机试验，比较了新咨询的LBP坐骨神经痛患者在接受或不接受早期物理治疗的情况下，常规的、基于指南的初始治疗的有效性。具体目的是比较附加物理疗法的临床疗效、成本(直接和间接)和成本效益。所有患者都将得到建议、教育和药物治疗。其中一组还将接受6-8次物理治疗结果，包括一年内残疾、疼痛、心理困扰、医疗保健、利用率和费用的测量。这项研究将允许对急性下腰痛和坐骨神经痛患者在初级保健中使用早期物理治疗的有效性和成本进行检查。这项研究的结果将提供必要的信息，以帮助临床医生，并告知患者他们对这种常见疾病的初始处理选择。

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.