Physiotherapy and low back pain in the injured worker: an examination of current practice during the subacute phase of healing

Abstract

Purpose: To describe current physiotherapy practice for injured workers with subacute low back pain (SA-LBP).

Method: A chart audit of discharged workers was conducted over three episodes of care: 4-6 weeks (T1), 6-8 weeks (T2), and 8-10 weeks (T3) post-injury. The prevalence and reproducibility of parameters for common interventions were calculated as the percentage of active charts over time. Focus groups were used to validate audit results and deepen our understanding of practice.

Results: In all, 164 charts were audited. The most prevalent interventions were (1) for manual therapy, joint mobilization and traction; (2) for electrophysical agents (EPAs), heat, ultrasound, and interferential therapy; and (3) for exercise, core stabilization exercises. Transcript analyses revealed that participants viewed injured workers with SA-LBP in a positive light, emphasized the importance of physiotherapy, and discussed SA-LBP in five themes: time frame, non-specific diagnosis, mixed client outlook, change in pain presentation, and the transition from a passive to a more active treatment approach.

Conclusions: The pattern of decreasing passive and increasing active interventions is consistent with the focus-group participants' description of how they approach treatment of clients with SA-LBP. Also noted was a higher prevalence of interventions poorly supported by evidence and lower prevalence of interventions well supported by evidence.

Keywords: chart audit; electrophysical agents; exercise; focus groups; manual therapy; subacute low back pain.

Figure 1

Percentage of active charts over time that included manual therapy interventions, according to specific technique; note that some charts recorded more than one manual therapy technique (MET = muscle energy technique)

Figure 2

Percentage of active charts that included manual therapy as an intervention that had documented parameters adequate for reproduction (number of active charts: n = 92 at T1; n = 79 at T2; n = 69 at T3)

Figure 3

Percentage of active charts that included electrophysical agents over time (IFT = interferential therapy; NMES = neuromuscular electrical stimulation)

Figure 4

Of charts that included electrophysical agents, percentage with documented parameters adequate for reproduction (IFT = interferential therapy; TENS = transcutaneous electrical nerve stimulation; NMES = neuromuscular electrical nerve stimulation)

Figure 5

Percentage of active charts with documentation of exercise prescription (number of active charts: n = 122 at T1, n = 118 at T2, n = 96 at T3)

Figure 6

Specific strengthening exercises as a percentage of active charts that included strengthening and functional exercise (core = core stabilization exercises; UE = upper extremity)