Physical Therapy for Low Back Pain

Recruiting at 1 trial location

Overseen By Kyle R Petrey, DPT

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Brooke Army Medical Center

Disqualifiers: Serious spinal pathology, Neurological disease, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 6 weeks

57 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how physical therapy might aid individuals with chronic low back pain by enhancing the body's natural pain management. Researchers believe that, for some, the body's pain control system may not function properly, potentially worsening their pain. The trial aims to determine whether physical therapy can address this issue and identify who will benefit most from therapy. It suits those who have experienced low back pain for over three months and can commit to at least six weeks of physical therapy. As an unphased trial, this study provides a unique opportunity to contribute to the understanding and improvement of pain management strategies.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that physical therapy is safe for treating low back pain?

Studies have shown that physical therapy for low back pain is generally safe and manageable. Research indicates that exercise therapy, often included in physical therapy, provides small benefits in managing pain and disability for those with low back pain. One study found that starting physical therapy early for sudden low back pain reduced healthcare use and spending within 30 days, suggesting it as a safe and effective initial treatment step. Overall, physical therapy is considered a low-risk option for managing long-term low back pain, with many patients experiencing successful outcomes. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about physical therapy for chronic low back pain because it offers a non-invasive approach that focuses on strengthening and flexibility, which can lead to long-term relief without medication side effects. Unlike standard treatments like pain medications or surgery, physical therapy aims to address the root cause of pain through personalized exercise plans. This treatment empowers patients to manage their pain actively, potentially reducing reliance on medications and improving overall quality of life.

What evidence suggests that physical therapy might be an effective treatment for low back pain?

Studies have shown that physical therapy can help people with chronic low back pain, especially in the short term. One study found that the benefits of physical therapy and exercise lasted up to a year after treatment. This suggests that physical therapy might not only relieve pain immediately but also offer long-term benefits. Another study suggests that combining physical therapy with exercise and other treatments might be the most effective way to reduce pain. Overall, physical therapy is generally considered a helpful approach for managing chronic low back pain. ^{2 6 7 8 9}

Who Is on the Research Team?

Kyle Petrey, DPT

Principal Investigator

BAMC

Are You a Good Fit for This Trial?

This trial is for English-speaking DEERS-eligible individuals aged 18-64 with chronic low back pain lasting over 3 months. Participants must have a disability index of at least 25% and pain intensity score of 3/10 or higher, and commit to six weeks of physical therapy.

Inclusion Criteria

I have had low back pain for more than 3 months.

I can commit to six weeks of physical therapy.

I am eligible for DEERS.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo a typical physical therapy plan of care to assess improvement in conditioned pain modulation

6 weeks

Weekly visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Physical therapy

Trial Overview

The study tests if standard physical therapy can improve the body's natural pain inhibition (conditioned pain modulation) in people with chronic low back pain. It also examines whether this modulation predicts the success of physical therapy treatment.

How Is the Trial Designed?

Group I: chronic low back pain Experimental Treatment 1 Intervention

Age 18-64 years with low back pain duration greater than 3 months.

Who Is Running the Clinical Trial?

Brooke Army Medical Center

Lead Sponsor

Trials

134

Recruited

28,100+

Published Research Related to This Trial

Early physical therapy (PT) for acute low back pain significantly reduces short-term pain and disability compared to non-PT care, with a moderate effect size based on a meta-analysis of 7 studies involving various participants.

However, early PT does not show significant advantages over delayed PT in terms of pain or disability outcomes, indicating that while early intervention is beneficial compared to no therapy, the timing of PT may not greatly impact long-term recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of physical therapy timing on patient-reported outcomes for individuals with acute low back pain: A systematic review with meta analysis of randomized controlled trials. McDevitt, AW., Cooper, CG., Friedrich, JM., et al.[2023]

In a study of 6,523 patients with low back pain, 42.7% achieved a 30% improvement in disability by the third physical therapy visit, and this increased to 49% by the sixth visit, indicating that many patients benefit from early intervention.

The initial and third visit disability scores were strong predictors of improvement, with excellent diagnostic accuracy (area under the curve values of 0.84 and 0.85) for forecasting significant clinical progress by the sixth visit, highlighting the importance of routine outcome assessments in physical therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Significant Clinical Improvement Was Predicted in a Cohort of Patients With Low Back Pain Early in the Care Process. Brennan, GP., Snow, G., Minick, KI., et al.[2023]

Patients with low back pain (LBP) who had symptoms for more than 6 months showed significantly less functional improvement after physical therapy compared to those with symptoms lasting less than 1 month, indicating that longer symptom duration may hinder recovery.

The study found that age, symptom duration, and specific types of exercises (mobilization/manipulation, strengthening, and flexibility) significantly influenced functional improvement, explaining over 55% of the variance in recovery outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changes in disability following physical therapy intervention for patients with low back pain: dependence on symptom duration. Badke, MB., Boissonnault, WG.[2015]

A systematic review and meta-analysis of six randomized controlled trials involving 387 participants found that hip-targeted physical therapy interventions did not lead to significant reductions in pain or disability for patients with low back pain.

The studies showed a trivial effect size for pain outcomes and a small effect size for disability, indicating that these interventions may not be effective, and all studies had a high risk of bias.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of hip-targeted physical therapy interventions on low back pain: A systematic review and meta-analysis. Bernet, BA., Peskura, ET., Meyer, ST., et al.[2019]

Physical therapists must effectively track outcomes for patients with low back pain to monitor treatment effectiveness, and this article reviews various measurement tools to aid in that process.

The article discusses the reliability and validity of common outcome measures, such as the SF-36 and Oswestry Questionnaire, providing practical guidelines for their selection and use in clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Guide to outcomes measurement for patients with low back pain syndromes. Resnik, L., Dobrzykowski, E.[2019]

Citations

1.

pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov/31794508/

Comparative Effectiveness of an Interdisciplinary Pain ...

The aim of this study was to compare the effectiveness of PT to an interdisciplinary treatment approach in patients with chronic low back pain (CLBP).

2.

jospt.org

jospt.org/doi/10.2519/jospt.2015.0105

Improving Long-Term Outcomes for Chronic Low Back Pain

The best evidence suggests that current physical therapy interventions for CLBP are likely to be helpful for many people in the short term.

3.

academic.oup.com

academic.oup.com/ptj/article/104/12/pzae128/7749962

Cognitive Functional Therapy for Chronic Low Back Pain

Low to moderate certainty of evidence was found that CFT is effective for pain in the short and medium terms and probably in the long term.

4.

nature.com

nature.com/articles/s41598-024-62276-9

Physiotherapeutic and non-conventional approaches in ...

Adapted physical exercise, physical agent modalities, and a multidisciplinary approach might represent the most effective strategy to reduce pain and ...

5.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC6709610/

Effectiveness of physical therapy and exercise on pain ...

Our study results showed that improvements were able to be sustained for one year after the treatment. Therefore, combined treatment with exercise, medical ...

6.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC12191304/

Benefits and harms of exercise therapy and physical ...

Exercise therapy and leisure-time physical activity provide small benefits for managing pain and disability in low back pain (LBP) and preventing recurrence.

7.

bmchealthservres.biomedcentral.com

bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-08255-0

Initial presentation for acute low back pain: is early physical ...

Early PT for acute LBP was associated with less 30-day and 1-year healthcare utilization and less 30-day LBP-related spending.

8.

sciencedirect.com

sciencedirect.com/science/article/abs/pii/S0003999319314455

Effect of Low Back Pain Chronicity on Patient Outcomes ...

Overall, this study shows patients experiencing shorter duration of LBP symptoms before starting a PT episode of care experience significantly better outcomes ...

9.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC6378502/

The Influence of an Active Treatment Approach in Patients ...

Furthermore, 64.7% of patients in the adherent group reported successful outcomes in physical therapy versus only 36.5% in the nonadherent group. Another study ...