The Struggle Is Real! I Cannot Believe What I Just Read!
The Journal of The American Medical Association published some research last week that, according to an article published on The New York Times Well blog, showed very little difference between the outcomes of patients with lower back pain who are treated with Physical Therapy and those that receive "usual care" for their lower back pain. I do my best to stay on top of the current research, so that we can provide the most evidence based care for our patients. However, I have to admit that the blog post caught me off guard and left me shaking my head. What complicated the situation is that a couple of patients brought the article to my attention before I even had a chance to read the actual research. So, after reading the article from The New York Times Well blog, which incidentally is where the patients came across the information, I have to admit that I felt the need to read that article for myself, as well as the published research. I was immediately turned off by the title of the article... "Physical Therapy May Not Benefit Back Pain." After reading both pieces, it became apparent to me that title chosen, by the author, demonstrates one of two things, a significant bias from the author or a lack of understanding regarding the treatments that are utilized.
Let's take a little look at the findings of the research and discuss what they really mean. First of all, the group of participants that received "physical therapy" were treated with "manipulation and exercise." That sounds a lot like what we use to treat patients in our office! I was excited to see what kind of conclusions they would be able to draw. I thought to myself that this study ought to yield results that we can use to improve our process too! Boy was I wrong! First of all, the patients were treated 4 times. Count 'em 4 WHOLE visits. How many exercises do you think that you can learn in 4 visits? We typically demonstrate and have our patients perform approximately 10 different exercises in 4 visits, BUT how many people would feel comfortable continuing to perform these exercises on their own outside of the office. Let me give you a little hint, NOT MANY. The headline that The New York Times article seems to be running with is based on the follow up at one year after the onset of their pain. Do you think that the people who barely learned the exercise in the first place will be able to follow through with doing them for 365 days... There is absolutely no way! Another major flaw in the research is that there is no specification as to the types of exercises that were utilized during the PT sessions. This is incredibly important. Are they just randomly assigning exercises, or are the exercises determined based on the cause of the patient’s pain? When dealing with lower back pain, some exercises will help some people, while they might increase other people's pain levels. Can you see why it is so difficult to draw conclusions like “Physical Therapy May Not Benefit Back Pain” from this published research?
This article has given me a nice soap box to climb on. Remember that "spin" exists in everything that you read and watch in terms of news! In this case, a little investigation revealed that the headline is VERY misleading!
If you would like to view the abstract for study published by the Journal of the American Medical Association, click this LINK.
Dr. William "Chip" Bleam