Doctors Add Hands-On Treatments for Low Back PatientsWhat if your family physician were trained to do some of the same basic moves used by chiropractors and physical therapists to help with low back problems? By adding these techniques to regular office visits, would you get better sooner, need less medication, and feel better about the care you received?
This study was designed to address such questions. Thirty-one general physicians trained for a total of 18 hours in how and when to use a set of manual therapy treatments that are more commonly given by physical therapists, osteopathic physicians, and chiropractors. The participants were shown five muscle energy techniques, treatments that rely on the patient's own muscle power to help stretch joints and soft tissues. They also learned how to use three different adjustment techniques.
A total of 295 patients with back pain were randomly placed into two groups. Half received a medical back care program alone. The other half got the same medical care program plus the hands-on treatments. Patients in both groups were evaluated every two weeks over a period of two months to see which approach worked best. The researchers compared how fast patients got better, how long they were off work, their ability to do their activities, and their level of satisfaction with their care.
The patients' answers showed that the extra hands-on treatments did help a few patients, at least a little. But differences between both groups were minor. Patients who received hands-on care were prescribed fewer muscle relaxation medications. But the number of visits, special X-ray tests, and the number of referrals to other health providers were about the same for each group. And both groups ended up needing about the same number of prescriptions for painkillers.
The hands-on treatment did have immediate benefits for some patients. Fourteen percent showed complete recovery after only one visit.
As for the doctors, more than half who used the hands-on techniques reported feeling optimistic that they were providing improved care for their patients. Still, the physicians didn't always follow the directions when doing the hands-on moves. On average, the doctors only used three of the eight treatment choices. Yet when more than four maneuvers were used, patients showed faster improvement by an average of 2.5 days.
The authors emphasize that the results of doctors in this study should not be compared with the results achieved by experts in manual therapy. The mixed results of this study suggest that doctors who get limited training won't necessarily work miracles for everyone. But there seem to be possible benefits when doctors use some hands-on techniques in the exam room.
P. Curtis, MD, et al. Training Primary Care Physicians to Give Limited Manual Therapy for Low Back Pain. In Spine. November 15, 2000. Vol. 25. No. 22. Pp. 2954-2961.
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