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。大多数腰痛和坐骨神经痛患者进入初级保健保健系统。最佳初级保健管理目前尚不清楚，很少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、脊髓注射和手术应保留给症状在4-8周内未减轻的患者，但这些手术的使用率正在迅速增加，部分原因是不确定可向患者提供哪些初始治疗方案。在最初的治疗阶段，物理治疗被认为是一种选择，但使用不一致。目前尚不清楚对腰痛和坐骨神经痛患者早期物理治疗的预期效果，以及它对临床结果或未来医疗保健利用的长期影响。我们的研究团队进行了一系列的临床试验，以明确最有效的物理治疗方法的证据

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.