Physical therapy can be an effective first line of treatment for severe back and neck discomfort.

Physical therapy can be an effective first line of treatment for severe back and neck discomfort.

A physical therapy-first approach programme called Comprehensive Spine has been launched by St. Luke’s University Health Network to address severe back and neck pain.

According to Aldo Carmona, MD, senior vice president for clinical integration for St. Luke’s University Health Network, members of the network realised back and neck pain was one of the most prevalent diagnoses that presented at the network and that patients were entering the system through different departments. This realisation led to the creation of Comprehensive Spine, which aims to prevent expensive ER visits, radiographs, opioid prescriptions, and unnecessary surgeries.


“The method wasn’t always consistent.
The effort to bring individuals where they needed to go was being made by a lot of people, but Carmona said that it was difficult for the network to understand how these patients were being treated since there are so many access points.
“What we have tried to do is basically be a resource for patients and doctors to be routed into a standardised programme where we have researched best practises and started people on early and effective physical therapy as the main aim and avoiding a lot of other complications,” the researcher said. -McMichael, Roberta


Delivering suitable therapy

According to Carmona, adopting a physical therapy-first strategy can simplify patient care access by ensuring that patients are treated by the right doctors.
According to him, 50% of patients who visited St. Luke’s University Health Network with acute low back pain went there via the ER or urgent care.

What we want to do is make it possible for patients to go to one of our specialist physical therapy sets, even if they have to go to the emergency room, according to Carmona.

Carmona observed that by offering a single phone number for the Comprehensive Spine programme, individuals may be classified as having a low, high, or intermediate risk of developing important medical conditions through the use of standardised questions administered by a trained nurse.

“We will correctly triage them to the right person, whether that is an emergency department or a surgeon’s office,” Carmona said. “If a patient is high risk for anything, any sort of medical concern, we will appropriately triage them to that person.”

Effective medical care

A multidisciplinary team at the Virginia Mason Spine Clinic in Seattle has improved the care of patients with low back and neck pain by sending them to “the right provider at the right time during their journey of care, with the least amount of cost and the highest amount of effectiveness,” according to Roberta McMichael, PT, DPT, OCS, physical therapist and clinical specialist at the Virginia Mason Spine Clinic. This method is similar to that used at St. Luke’s University Health Network.

She said that by using an educational strategy, patients are given the tools to control their symptoms and are taught the proper exercises and self-care to keep their pain from becoming worse.

According to McMichael, “the physical-therapy-first approach has been demonstrated to be an effective, empowering treatment paradigm or design where patients can get convenient access to high-quality care from a provider who is able to screen them for any more recent medical conditions and appropriately refer them.”

Physical therapy advantages

Studies have proven cost benefits to patients and the health care system with a physical therapy-first strategy vs. typical treatment, in addition to providing the patient with the proper care in a timely way, McMichael said.

“When a patient first sees a physical therapist, the likelihood that they would afterwards have sophisticated imaging, like an MRI/CT scan, is substantially lower.
They are considerably less likely to undergo surgery later on and receive injections that may or may not be beneficial for them, according to the expert.

Carmona pointed out that by offering narcotic-free drugs for shorter periods, a physical therapy-first strategy may also aid in reducing the intake of opioids.

According to Carmona, “[Acute back or neck discomfort is] a prevalent condition that is frequently treated aggressively, perhaps incorrectly.”
As per normal, start with measures that cause the least damage, such as the safest pharmaceuticals, and save the powerful weapons and intensive treatments for when other measures fail.
To be honest, 90% of it should be readily treatable with effective physical therapy, effective short-term medicine, and just excellent education and caring for individuals.

How to put it into practise

Do your research, Carmona advised organisations planning to implement a physical therapy-first strategy for the treatment of back and neck pain.

This wasn’t merely a plan we came up with and wrote down, the man continued.
“You need a huge lot of coordination, a tremendous amount of buy-in, and a significant amount of education for both clinicians and patients if it is going to succeed,” said the author.

The information technology department, the hospital network, and the physical therapy department should all be on board with the implementation, the speaker added.

Physical therapists should establish a connection with other referral sources and have statistics to back up the effectiveness of their treatment approaches, according to McMichael.

The right triage tools are important for ensuring that our patients are treated effectively by the right doctors, according to McMichael.
Casey Tingle