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Physiotherapy is a long established therapy in lower back pain. It is unknown if physiotherapeutic interventions in patients presenting to the Emergency Department (ED) with nonspecific lower back pain are beneficial. The aim of this study is to assess whether patients presenting to the emergency department with non-specific low risk low back pain would benefit from a physiotherapy intervention, as compared to patients without physiotherapy intervention at time of ED presentation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| intervention group | Experimental | The study intervention is a brief physiotherapeutic assessment, a brief information on the expected course of the condition, and a brief instruction on self-management, including three exercises for daily self-guided therapy. |
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| control group | No Intervention | The control group will receive written information on the expected course of the condition, written instructions on self-management and written instructions on exercises for daily self-guided therapy. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| physiotherapeutic intervention | Other | The intervention consists of a brief physiotherapeutic assessment by a short physical performance battery, a brief information on the expected course of the condition and instructions on self-management regarding back friendly behaviour (eg. respecting the pain, staying active and back friendly movement strategies). Additionally, three exercises for daily self-guided therapy are included to the intervention: Turning in bed and coming to a sitting position, sit to stand and squats standing in front of a wall. |
| Measure | Description | Time Frame |
|---|---|---|
| Oswestry Disability Index (ODI) | This self-completed questionnaire contains ten topics concerning intensity of pain, lifting, ability to care for oneself, ability to walk, ability to sit, sexual function, ability to stand, social life, sleep quality, and ability to travel. Each topic category is followed by 6 statements describing different potential scenarios in the patient's life relating to the topic. The patient then checks the statement which most closely resembles their situation. Each question is scored on a scale of 0-5 with the first statement being zero and indicating the least amount of disability and the last statement is scored 5 indicating most severe disability. The scores for all questions answered are summed, then multiplied by two to obtain the index (range 0 to 100). Zero is equated with no disability and 100 is the maximum disability possible. | At Day 0 and at Day 7 ± 7 days |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Numeric Rating Scale (NRS) | The NRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain ('0' representing one pain extreme (e.g. "no pain") to '10' representing the other pain extreme (e.g. "pain as bad as you can imagine")) | At Day 0, Day 7 ± 7 days, Day 21 ± 3 days, Day 42 ± 3 days |
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Inclusion Criteria:
Exclusion Criteria:
Inpatient disposition after ED work-up
"Red Flags" at time of ED-presentation:
Epidural steroid injections in the last 3 months
Inability or contraindications to undergo the investigated intervention or to follow the study procedures, e.g. due to certain neurological disorders, language problems, psychological disorders, cognitive impairment, physical inability etc.
Prior enrolment in this trial
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| Name | Affiliation | Role |
|---|---|---|
| Roland Bingisser, Prof. Dr. med. | Emergency Department University Hospital Basel | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Emergency Department University Hospital Basel | Basel | 4031 | Switzerland |
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| ID | Term |
|---|---|
| D017116 | Low Back Pain |
| ID | Term |
|---|---|
| D001416 | Back Pain |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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| Feasibility of the intervention | The questionnaire was completed by the physiotherapist after the intervention and consisted of six questions about the feasibility of the physiotherapeutic intervention. Each question had a scale of 1 (= no, strongly disagree) to 6 (=yes, strongly agree) for possible answers. | At Day 0 |
| Patient satisfaction | This self-completed questionnaire contains six questions about patient satisfaction with their ED visit on day 0. Each question could be answered with a score from 0 (not at all) to 10 (very much). | At Day 7 ± 7 days |
| Adherence to therapy recommendations | Patients were asked if they were able to adhere to the behavioral and exercise recommendations given to them on Day 0. | At Day 7 ± 7 days |
| StarT Back Screening Tool (SBST) | The SBST categorises back pain patients into 3 categories: low, medium and high risk. It consists of 9 items, each with a value of 0 or 1 points. The SBST Score is calculated by summing the points from each question, with a minimum score of 0 points and a maximum score of 9 points. | Day 0, Day 7 ± 7 days, Day 42 ± 3 days |
| Oswestry Disability Index (ODI) | This self-completed questionnaire contains ten topics concerning intensity of pain, lifting, ability to care for oneself, ability to walk, ability to sit, sexual function, ability to stand, social life, sleep quality, and ability to travel. Each topic category is followed by 6 statements describing different potential scenarios in the patient's life relating to the topic. The patient then checks the statement which most closely resembles their situation. Each question is scored on a scale of 0-5 with the first statement being zero and indicating the least amount of disability and the last statement is scored 5 indicating most severe disability. The scores for all questions answered are summed, then multiplied by two to obtain the index (range 0 to 100). Zero is equated with no disability and 100 is the maximum disability possible. | Day 21 ± 3 days, Day 42 ± 3 days |
| Pain medication use | Questions about the use of pain medication and how long pain medication have been used. | At Day 0, Day 7 ± 7 days, Day 21 ± 3 days, Day 42 ± 3 days |
| Utilization of medical resources | Patients were asked if they had seen a physiotherapist, an emergency department, a general practitioner, a specialist, been hospitalized or had imaging since the last contact. | At Day 7 ± 7 days, Day 21 ± 3 days, Day 42 ± 3 days |
| Ability to work | Patients were asked if they were going back to work. | At Day 7 ± 7 days, Day 21 ± 3 days, Day 42 ± 3 days |
| D013568 |
| Pathological Conditions, Signs and Symptoms |