The Effect of Timing of Physical Therapy for Acute Low Back Pain on Health Services Utilization: A Systematic Review

Arch Phys Med Rehabil. 2019 Jul;100(7):1324-1338. doi: 10.1016/j.apmr.2018.11.025. Epub 2019 Jan 24.


Objective: To synthesize literature about the effect of early physical therapy (PT) for acute low back pain (LBP) on subsequent health services utilization (HSU), compared to delayed PT or usual care.

Data sources: Electronic databases (MEDLINE, CINAHL, Embase) were searched from their inception to May 2018.

Study selection: Study selection included randomized control trials and prospective and retrospective cohort studies that investigated the association between early PT and HSU compared to delayed PT or usual care. Two independent authors screened titles, abstracts, and full-text articles for inclusion based on eligibility criteria, and a third author resolved discrepancies. Eleven out of 1146 articles were included.

Data extraction: Two independent reviewers extracted data on participants, timing of PT, comparisons to delayed PT or usual care, and downstream HSU, and a third reviewer assessed the information to ensure accuracy and reach consensus. Risk of bias was assessed with the Downs and Black checklist using the same method.

Data synthesis: Eleven studies met eligibility criteria. Early PT is within 30 days of the index visit for acute LBP. Five out of 6 studies that compared early PT to delayed PT found that early PT reduces future HSU. Random effects meta-analysis indicated a significant reduction in opioid use, spine injection, and spine surgery. Five studies compared early PT to usual care and reported mixed results.

Conclusions: Early PT for acute LBP may reduce HSU, cost, and opioid use, and improve health care efficiency. This review may assist patients, health care providers, health care systems, and third-party payers in making decisions for the treatment of acute LBP.

Keywords: Health care costs; Low back pain; Physical therapy modalities; Rehabilitation; Time factors.

Publication types

  • Systematic Review

MeSH terms

  • Acute Disease
  • Facilities and Services Utilization*
  • Humans
  • Low Back Pain / therapy*
  • Physical Therapy Modalities*