Physiotherapy intervention INCREASES risk of NOT Returning to Work!!??!!**#%

Reference:Reme SE, et al Expectations, perceptions, and physiotherapy predict prolonged sick leave in subacute low back pain. BMC Musculoskeletal Disorders. 2009; 10:139.

This Norwegian RCT investigated predictors of return to work in 176 patients with sub-acute low back pain. They wanted to identify predictors for non-return to work.

Shocking Results: At 3 months, and at 1 year the strongest factors for a POOR prognosis for return to work were basically…

1) Negative expectations / pessimism about returning to work at initial consult (Of course that is no surprise!)

2)Negative / catastrophic perceptions about pain and disability (Of course that is no surprise either!)

3)Having been to a physiotherapist prior to participation in the trial…yes you read it right?past Physiotherapy intervention predicted prolong sick leave (That is an absolutely shocking result… until you read the full article!)

The study mentions, “This is the first study reporting that previous treatment by physiotherapists is a risk factor for long-term sick leave.”

After reading the study abstract, I got a little depressed and felt down…all these years I?ve been writing about amazing Physio research studies showing positive outcomes and here we are in 2010, with a study like this! But wait?then I got the full article and read more than just the abstract, and what did I see?

I am actually going to quote the article, “The type of physiotherapy treatment most frequently reported was passive treatments such as hot packs, massage, and ultrasound”.

After reading this sentence, I gained my confidence back in the Physiotherapy profession and said to myself, “that explains the poor outcome”. Also the patients who seek passive modalities are likely to have more passive coping strategies which is a predictor of poor outcomes…likely not the Physio?s fault then, but it is simply the type of patients they attracted!

However, I do believe that our profession would excel so much more if we dramatically reduced our reliance on modalities! I?d like to see just one good study that ever showed that a passive modality (IFC, US, TENS, SWD, PEMF) helped improve patient return to work outcomes!

Excessive passive modalities are not only harmful to the profession, they are also ‘harmful’ to patients. They promote dependency and further add to patients’ pain focused behaviours. Modalities are not evidence-based when it comes to functional outcomes and return to work. And yet… Universities continue to happily teach them!

Perhaps as more studies come out showing that Modality Focused Physiotherapy is truly harmful, we will wake up! Chasing patients’ pain rarely works! To date the evidence is clear that only by empowering patients on self-management and a short course of manual therapy /spinal manipulation (if needed) is there a hope of reducing chronic disability.

Posted on: July 02, 2010

Categories: Lumbar Spine

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