Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica : A Randomized Controlled Trial

Ann Intern Med. 2021 Jan;174(1):8-17. doi: 10.7326/M20-4187. Epub 2020 Oct 6.


Background: Few studies have examined primary care management for acute sciatica, including referral to physical therapy.

Objective: To evaluate whether early referral to physical therapy reduced disability more than usual care (UC) alone for patients with acute sciatica.

Design: Randomized controlled clinical trial. ( NCT02391350).

Setting: 2 health care systems in Salt Lake City, Utah.

Patients: 220 adults aged 18 to 60 years with sciatica of less than 90 days' duration who were making an initial primary care consultation.

Intervention: All participants received imaging and medication at the discretion of the primary care provider before enrollment. A total of 110 participants randomly assigned to UC were provided 1 session of education, and 110 participants randomly assigned to early physical therapy (EPT) were provided 1 education session and then referred for 4 weeks of physical therapy, including exercise and manual therapy.

Measurements: The primary outcome was the Oswestry Disability Index (OSW) score after 6 months. Secondary outcomes were pain intensity, patient-reported treatment success, health care use, and missed workdays.

Results: Participants in the EPT group had greater improvement from baseline to 6 months for the primary outcome (relative difference, -5.4 points [95% CI, -9.4 to -1.3 points]; P = 0.009). The OSW and several secondary outcomes favored EPT after 4 weeks. After 1 year, between-group differences favored EPT for the OSW (relative difference, -4.8 points [CI, -8.9 to -0.7 points]) and back pain intensity (relative difference, -1.0 points [CI, -1.6 to -0.4 points]). The EPT group was more likely to self-report treatment success after 1 year (45.2%) than the UC group (27.6%) (relative risk, 1.6 [CI, 1.1 to 2.4]). There were no significant differences in health care use or missed workdays.

Limitation: The patients and providers were unblinded, and specific physical therapy interventions responsible for effects could not be determined.

Conclusion: Referral from primary care to physical therapy for recent-onset sciatica improved disability and other outcomes compared with UC.

Primary funding source: Agency for Healthcare Research and Quality.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Pain / etiology
  • Acute Pain / rehabilitation*
  • Adolescent
  • Adult
  • Female
  • Humans
  • Low Back Pain / complications
  • Low Back Pain / rehabilitation*
  • Male
  • Middle Aged
  • Physical Therapy Modalities*
  • Primary Health Care / methods*
  • Referral and Consultation*
  • Sciatica / complications
  • Sciatica / rehabilitation*
  • Secondary Prevention / methods*
  • Single-Blind Method
  • Young Adult

Associated data