Physiotherapy-led care versus physician-led care for persons with low back pain: A systematic review

• Published in: Clinical rehabilitation Vol. 38; no. 12; pp. 1571 - 1589
• Main Authors: Severijns, Pieter, Goossens, Nina, Dankaerts, Wim, Pitance, Laurent, Roussel, Nathalie, Denis, Corentin, Fourré, Antoine, Verschueren, Pieter, Timmermans, Annick, Janssens, Lotte
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-12-2024; Sage Publications Ltd
• Subjects: Back pain; Clinical outcomes; Cohort analysis; Cost analysis; Costs; Drugs; Emergency services; Health care expenditures; Hospitalization; Low back pain; Patient satisfaction; Patients; Physical therapists; Physical therapy; Physicians; Physiotherapy; Primary care; Sick leave; Systematic review; Uncertainty; direct access; primary care; emergency care; Low back pain; physiotherapy
• ISSN: 0269-2155; 1477-0873; 1477-0873
• DOI: 10.1177/02692155241282987

Objective
To summarise the evidence on the effect of physiotherapy-led versus physician-led care on clinical outcomes, healthcare use, and costs in persons with low back pain.
Data sources
PubMed, Web of Science, CINAHL, Embase, and PEDro were systematically searched with the latest search performed in July 2024. Reference lists of articles were hand-searched.
Review methods
Studies comparing clinical outcomes, healthcare use, or costs between adults with low back pain first consulting a physiotherapist and those first consulting a physician were included. Methodological quality was assessed with the Newcastle-Ottawa Scale. Study design, clinical setting, patient characteristics, and group effects were extracted. Findings on outcomes assessed in two or more studies were synthesised narratively. Certainty of evidence was determined using the GRADE approach.
Results
Eighteen studies comprising 1,481,980 persons with low back pain were included. Most studies were non-randomised retrospective or prospective cohort studies. In primary care (15 studies), consistent evidence, though of mostly very low certainty, indicated that physiotherapy-led care leads to higher patient satisfaction, less use of medication, injections and imaging, fewer physician's visits, lower total healthcare costs, and less sick leave compared to physician-led care, without increased harm. In emergency care (three studies), evidence of very low certainty showed that physiotherapy-led care leads to shorter waiting and treatment times, and fewer hospital admissions.
Conclusion
Physiotherapy-led care is a clinically, time- and cost-effective care pathway for low back pain, although the certainty of evidence was overall very low. Further high-quality research with a greater focus on clinical outcomes is warranted.