Developing, testing and refining a physiotherapy model of care for acute low back pain

Abstract

This thesis is concerned with the physiotherapy management of acute low back pain. Various national guidelines contain conflicting views regarding the role of physiotherapy in the management of acute low back pain. The discrepancies involve primarily the content and timing of physiotherapy intervention. There is a need to place the physiotherapy management of acute low back pain on a more firm research base. A comprehensive literature review was undertaken to develop a best practice model of care for acute low back pain. This model was tested in a randomised controlled trial. Subjects involved in the treatment model demonstrated significantly better short-term outcomes than subjects given advice only. Furthermore, subjects treated early demonstrated significantly better long-term outcome than subjects who waited six weeks for their treatment. Changes in pain and physical function were found to be the factors most closely associated with good outcome in the short-term. Good outcome in the long term was associated with improvement in a number of physical and psychological variables. It is recommended that changes be made to the treatment model to facilitate improvement in pain relief and maintenance of physical and social function to further enhance treatment effectiveness.