On-Site Physiotherapy in Emergency Department Patients Presenting with Nonspecific Low Back Pain: A Randomized Controlled Trial

Abstract

Background: There is a high incidence of nonspecific Low Back Pain (LBP) in patients visiting Emergency Departments (EDs), but there is a lack of knowledge regarding emergency physiotherapy for LBP. The effect of on-site physiotherapy in these patients was therefore never demonstrated. We assessed short-term outcomes, feasibility and patient satisfaction with physiotherapy in ED patients presenting with nonspecific LBP. Methods: A block-randomized, controlled, open-label trial with a follow-up of 42 days. Patients aged 18 years or older presenting to an ED with nonspecific LBP were prospectively enrolled. Both groups received the same booklet with written information on LBP management and exercises. Patients in the intervention group were given additional instructions by a certified physiotherapist. Results: We included 86 patients in the primary analysis. The median age was 40, and 40.7% were female. At day 7, the median Oswestry Disability Index (ODI) was 2 points lower in the intervention group compared to the control group, which was not statistically significant. There was no between-group difference in pain at day 7. Patients who received physiotherapy felt significantly more confident with the exercises they were taught (p = 0.004, effect size = 0.3 [95% CI 0.1 to 0.5]). Conclusions: On-site physiotherapy in ED patients presenting with nonspecific low back pain is associated with higher patient satisfaction, compared to standard of care. The effect of physiotherapy was small, with only minimal improvement in disability, but without a reduction in pain. Despite the very small effect size, physiotherapeutic interventions should be investigated in larger cohorts with an extended intervention including patient education, exercises, and other physiotherapeutic modalities.

Keywords: disability; emergency department; feasibility; nonspecific low back pain; physiotherapy; randomized controlled trial; satisfaction.

Figure 1

Illustration of the three exercises. This is an extract from the booklet that was provided to each participant at baseline. The three exercises (turning in bed and coming to a sitting position, sit to stand and dynamic wall squats) are each described with written and pictorial explanations.

Figure 2

Flow chart of the study population. The chart displays recruitment procedure of emergency department patients aged 18 or older presenting with nonspecific low back pain.

Figure 3

Boxplot of the Oswestry Disability Index at day 7. Boxplot comparing ODI at day 7 between control group and intervention group. Single points symbolize patients. Box contains Interquartile Range (IQR) and horizontal line inside the box indicates the median.

Figure 4

Radar chart of the patient satisfaction at day 7. Patients completed a questionnaire about their satisfaction with their ED visit. Answers were recorded on a Numeric Rating Scale (NRS) from 0 (=not at all) to 10 (=very much). Displayer values are medians.