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. 2009 Spring;61(2):88-106.
doi: 10.3138/physio.61.2.88. Epub 2009 May 12.

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

Katherine Harman  1 , Anne Fenety, Alison Hoens, James Crouse, Bev Padfield
Affiliations

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

Katherine Harman et al. Physiother Can. 2009 Spring.

Abstract
in English, French

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.

Objectif : Décrire la pratique actuelle en physiothérapie pour les accidentés du travail atteints d'une lombalgie dans la phase subaiguë de guérison.

Méthode : On a examiné les dossiers de travailleurs ayant reçu leur congé, et ce, en fonction de 3 périodes de traitement : de 4 à 6 (T1), de 6 à 8 (T2) et de 8 à 10 semaines après la survenue de la lésion. La prévalence et la reproductibilité des paramètres inhérents aux interventions courantes ont été calculées par rapport au pourcentage des dossiers actifs au fil du temps. On a fait appel à des groupes de discussion pour valider les résultats de l'examen des dossiers et mieux comprendre la pratique.

Résultats : L'examen a porté sur 164 dossiers. Les modalités d'intervention les plus courantes ont été (1) la mobilisation articulaire et la traction en matière de thérapeutique manuelle ; (2) la chaleur, les ultrasons et l'électrothérapie à courants interférentiels pour ce qui est des agents électrophysiologiques et (3) les exercices de stabilisation des muscles du tronc pour ce qui est des exercices. L'analyse des transcriptions a révélé que les participants avaient une opinion positive des accidentés du travail souffrant de lombalgie subaiguë; ils ont souligné l'importance de la physiothérapie et ont abordé la lombalgie subaiguë en fonction de 5 thèmes : le bloc de temps, le diagnostic non spécifique, le portrait diversifié de la clientèle, le tableau changeant de la douleur et la démarche thérapeutique (transition d'un traitement passif à un traitement plus active au cours de la période du traitement).

Conclusions : La tendance voulant que l'on intervienne de plus en plus activement cadre avec la façon dont les groupes de discussion ont décrit leur démarche thérapeutique auprès des patients souffrant de lombalgie subaiguë. Il est par ailleurs à noter que la prévalence des interventions moins bien étayées était supérieure à celle des interventions recueillant un fort appui.

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

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Figures

Figure 1
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
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
Figure 3
Percentage of active charts that included electrophysical agents over time (IFT = interferential therapy; NMES = neuromuscular electrical stimulation)
Figure 4
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
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
Figure 6
Specific strengthening exercises as a percentage of active charts that included strengthening and functional exercise (core = core stabilization exercises; UE = upper extremity)
See this image and copyright information in PMC

References

    1. Merskey H, Bogduk N, editors. Classification of chronic pain: descriptions of chronic pain syndrome and definitions of pain terms. 2nd. Seattle, WA: IASP Press; 1994.
    1. Waddell G. The back pain revolution. Toronto: Churchill Livingstone; 1998.
    1. Canadian Pain Society Task Force on Wait Times. Establishing acceptable waiting times for treatment of pain in Canada. Oshawa, ON: Canadian Pain Society; 2006.
    1. Ospina M, Harstall C. Prevalence of chronic pain: an overview. Edmonton: Alberta Heritage Foundation for Medical Research, Health Technology Assessment; 2002.
    1. Boulanger A, Clark A, Squire P, Cui E, Horbay G. Chronic pain in Canada: have we improved our management of chronic noncancer pain? Pain Res Manage. 2007;12:39–47. - PMC - PubMed

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