Background & Aims
Spinal pain is affecting approximately a billion individuals worldwide.1 In many countries, the waiting times for accessing specialized care for complex spinal pain conditions have consistently increased, highlighting the limitations of the traditional physician-led model.2
The use of advanced practice physiotherapy (APP) models of care, in which physiotherapists have more responsibilities related to traditionally medical or controlled acts, has emerged as a viable solution to enhance healthcare accessibility for musculoskeletal pain.3-5 These models are at least as effective as traditional models of care.6 However, it remains unclear if an approach involving multiple sessions would be superior to one with a single session with an advanced practice physiotherapist (APPT).6, 7
The aim of this study was to assess the clinical effectiveness of a single session compared with multiple sessions of education and exercise for adults with spinal pain in an APP specialized spine model of care
Methods
In this pragmatic randomized controlled trial, adults with a neck or back pain referred by a family physician for a spine surgery consultation, but considered nonsurgical cases by the APPT were randomized to receive either a single session or multiple sessions. In the first consultation, each participant received a home exercise program as well as education and advice from the APPT. Participants in the multiple session group also received five 30-minute follow-up sessions with the APPT.
The primary outcomes were the BPI pain severity and pain interference scales8 measured at 6, 12, and 24 weeks. Secondary outcomes included disability, pain catastrophizing and health-related quality of life questionnaires. Linear mixed models were performed to determine whether outcomes differ between treatment arms across time points.
Satisfaction was measured after the initial consultation with the VSQ9 and at 12 weeks with the MedRisk.10 Mann Whitney U tests were used to compare groups.
Results
One hundred and six participants were randomized in the single (n=52) or multiple sessions (n=54). Participants had a neck (n=25) or lumbar (n=81) pain conditions, a mean age of 61 years old and most had a chronic pain condition (92%).
Multiple sessions did not significantly improve the BPI severity compared to a single session (p=0.084). For the BPI interference, there was a significant group-by-time (p=0.046) interaction. The BPI interference was significantly lower in the multiple sessions group when compared to the single session group but only at the 6-week time point (mean difference: -0.96; 95%CI: -1.87 to -0.05).
Multiple sessions did not significantly improve disability, pain catastrophizing and health-related quality of life when compared to a single session.
Participants in the multiple sessions group were significantly more satisfied with care after the initial consultation based on the VSQ and MedRisk scores (p<0.05).
Conclusions
Based on this pragmatic randomized controlled trial, adults with spinal pain conditions showed similar clinical outcomes with either a single or multiple sessions of rehabilitation with an APPT in a specialized spine care model. However, those receiving multiple sessions reported a greater level of satisfaction. It remains unclear if certain subgroups might benefit from more extensive care.
References
1.Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020;396(10267): 2006-2017.
2.Moir M, Barua B. Waiting Your Turn: Wait Times for Health Care in Canada, 2022 Report. 2022.
3.Lafrance S, Lapalme J-G, Méquignon M, Santaguida C, Fernandes J, Desmeules F. Advanced practice physiotherapy for adults with spinal pain: a systematic review with meta-analysis. European Spine Journal. 2021;30(4): 990-1003.
4.Samsson K, Grimmer K, Larsson M, Morris J, Bernhardsson S. Effects on health and process outcomes of physiotherapist-led orthopaedic triage for patients with musculoskeletal disorders: a systematic review of comparative studies. BMC musculoskeletal disorders. 2020;21(1): 1-20.
5.World Confederation for Physical Therapy. WCPT Policy Statement: Advanced Physical Therapy Practice; 2020. https://www.wcpt.org/policy/ps-advanced-pt-practice.
6.Lafrance S, Raphaël V, Demont A, Charron M, Desmeules F. Advanced practice physiotherapy for adults with spinal pain: a systematic review with meta-analysis. Journal of physiotherapy. 2023;69(4): 220-231.
7.Dubé M-O, Dillon S, Gallagher K, Ryan J, McCreesh K. One and Done? The effectiveness of a single session of physiotherapy compared to multiple sessions to reduce pain and improve function and quality of life in patients with a musculoskeletal disorder: a systematic review with meta-analyses. Archives of Physical Medicine and Rehabilitation. 2023.
8.Keller S, Bann CM, Dodd SL, Schein J, Mendoza TR, Cleeland CS. Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. The Clinical journal of pain. 2004;20(5): 309-318.
9.Rubin HR, Gandek B, Rogers WH, Kosinski M, McHorney CA, Ware JE. Patients’ ratings of outpatient visits in different practice settings: results from the Medical Outcomes Study. Jama. 1993;270(7): 835-840.
10.Beattie P, Turner C, Dowda M, Michener L, Nelson R. The MedRisk instrument for measuring patient satisfaction with physical therapy care: a psychometric analysis. Journal of Orthopaedic & Sports Physical Therapy. 2005;35(1): 24-32.
Presenting Author
Simon Lafrance
Poster Authors
Simon Lafrance
MSc
Université de Montréal and Hôpital Maisonneuve-Rosemont Research Center
Lead Author
Carlo Santaguida
MD
Lead Author
Kadija Perreault
PhD
Center for Interdisciplinary Research in Rehabilitation and Social Integration, Canada
Lead Author
Brenna Bath
PT
Lead Author
Luc J. Hébert
fellow PT
Lead Author
Debbie Feldman
PT
Lead Author
Kednapa Thavorn
PhD
Lead Author
Julio Fernandes
MD
Lead Author
Francois Desmeules
University of Montreal
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Low Back Pain