World Physical Therapy Day 2024

World PT Day is observed to generate awareness about the crucial contribution physiotherapists make to society, enabling people to be mobile, well, and independent. This is observed annually on the 8th September. Designated in 1996, World PT Day is promoted by World Physiotherapy.

The focus for this year’s World PT Day on 8 September is low back pain and the crucial role physiotherapists

play in its management and prevention.

The big picture

Low back pain (LBP) is a big problem. Affecting approximately 10% of the population worldwide, it often leads to psychological distress and a poorer health-related quality of life. In Australia, around 4 million people, or 16% of the of the population, are estimated to be living with back pain at any one time. It is the third leading cause of disease burden overall, at a annual cost of about $3.4 billion (2020-2021), representing 2.2% of total health expenditure and 23% of expenditure for all musculoskeletal problems. 

Worldwide the incidence of LBP is escalating, particularly in low-income and middle-income countries. In 2020 studies estimated that about 10% of the worlds population suffered from LBP, accounting for 8.1% of all-cause years lived with disability globally. Low back pain is commonly associated with other conditions, particularly mental and behavioural conditions, arthritis, and asthma, and is the main reason for premature exit out of the workforce. Its higher prevalence in low and middle-income populations means it often co-exists with higher rates of diabetes, cardiovascular disease, and cerebrovascular disease.

For an overview of low back pain, click here.

Economic and societal burden

Despite being a leading cause of disability worldwide and a major cause for exit from the workforce, low back pain remains poorly understood and a low priority for governments and health policy makers world wide.

Consider the following:

• In Australia, low back pain is the leading cause of disability burden, lost work productivity and early retirement. Studies have shown that physiotherapy-led cognitive functional therapy for chronic disabling LBP, on average, reduced the cost of LBP treatment by $5,000 per year for every patient, mostly through getting people back to work.
• In Brazil, LBP accounted for 100 days absent from work per person between 2012 and 2016. The productivity losses accounted for nearly 80% of the country's annual cost of LBP of US$2.2 billion.
• In the UK, the cost of LBP from GP appointments alone is estimated at £5 billion annually. The introduction of a stratified care approach, STarT Back,  has significantly decrease disability from back pain, reduced time off work and saved money by making better use of health resources. The return on investment of STarT Back is estimated at £226 for every £1 spent to implement it.
• In the USA in 2016, back and neck pain cost US$134 billion. Early physiotherapy treatment over usual care resulted in an average net benefit of US$4,160 per person.

What works for low back pain?

It is now well recognized that a patient-centred biopsychosocial approach to the treatment and management of low back pain leads to the best outcomes for individuals.  Recommended non-surgical interventions include:

• Education programs that support knowledge and self-care strategies
• Exercise programs
• Judicious and timely use of physiotherapy interventions such as manual therapy
• Psychological therapies such as congnitive behavioural therapy
• Medicines such as non-steroidal anti-inflammatory medicines

Working as part of a collaborative, multi-disciplinary team ideally places physiotherapists as the rehabilitation specialists for the management of low back pain.

What's NOT recommended

Research into the treatment and management of low back pain has made significant progress over the past decade, and the evidence is mounting against low-quality treatment approaches and interventions.  It is important to recognize that while some of the following may provide some clinical improvement in some cases, they should not replace treatment strategies with proven effectiveness.

The following treatments are now NOT recommended for low back pain:

• Traction
• Therapeutic ultrasound
• transcutaneous electrical nerve stimulation (TENs)
• Orthotics
• Assistive products including lumbar braces, belts and supports, and mobility assitive products
• Mindfulness-based stress reduction therapy
• Opiod analgesics
• Anti-depressants
• Skeletal muscle relaxants
• Glucocorticoids
• Benzodiazepines
• Injectible local anaesthetics
• Weight management
• Paracetamol
• Spinal injections
• Spinal fusion
• Disc replacement

Sources: WHO (2023), National Institute for Health and Care Excellence (2020), Wewege et al. (2023).

The role of Physiotherapy

Physiotherapy plays a crucial role in the treatment and management of low back pain.  In Australia, physiotherapists are primary care practitioners. This means they are able to assess and diagnose their patients within their scope of practice.  Physiotherapist's are an integral part of a multi-disciplinary health care team, working closely with doctors, specialists, radiologists, pharmacists, psychologists, and other allied health professionals to optimise the treatment and mangement of low back pain. Their breadth of training and experience enables them to assess low back pain, gauge the impact of symptoms on functional capacity, and effectively guide patients on how to keep active and manage symptoms, and reduce the risk of future episodes of LBP.

The clinical care standard for low back pain includes:

• An initial clinical assessment that includes a psychosocial assessment to guide management
• Education and advice on staying active and returning to usual activity, including work, as soon as possible.
• Education and advice on self management strategies, including prescribed exercise and progressions.

Regular physical activity and exercise are important in the management of low back pain. Evidence informed research and clinical experience has clearly demonstrated the importance of staying active and keeping moving both during and following an episode of low back pain. Physiotherapists are well placed to prescribe, modify, and progress therapeutic exercise, adjust daily activity levels, set achievable personal goals, and help you find the right balance between rest and activity. 

The value of walking

It is estimated that 70% of people who experience low back pain will have a recurrence within 12 months.  A recent Australian study, titled the WalkBack trial for low back pain, looked at the impact of a progressive walking program on prevention of low back pain. The study, a randomized controlled study, included 701 participants (351 in the intervention group, 350 in the control group) who had recently recovered from an episode of low back pain. Participants in the intervention group received 6 sessions of physiotherapy over a 6 month period, which involved education about our current understanding of LBP, reassurance, and advice regarding a tailored, progressive walking program. Participants in the control group were provided with usual care (which is usually no care), though they were free to seek out treatment or prevention strategies as required.

At the conclusion of the study, the researchers found a statistically significant reduction (28%) in the risk of recurrence. The median days to recurrence was 208 days in the intervention group compared to 112 days in the control group. The intervention was found to be cost-effective, with a reduction in work absenteeism the largest financial benefit. 

The take home

The challenge of managing the increasing global burden of low back pain requires a commitment from government and policy makers to change how care is delivered, and the courage of health care professionals to challenge old fashioned models of care for low back pain.  Through education and evidence-backed advice, physiotherapists have the opportunity to dispel many of the myths surrounding the management of low back pain, reduce the economic imact of this condition and improve outcomes for clients. 

Have you got low back pain or recently recovered from an episode of low back pain? Give us a call.

We are part of a well-connected network of physiotherapists, massage therapists, doctors and specialists and offer a range of

physiotherapy services to help you manage your low back pain symptoms.

Call now on 08 8945 3799 or book online.

For more evidence based information on low back pain, visit Australian Physiotherapy Association and follow the social media campaigns using #WorldPTDay.

Sources.

1. Australian Physiotherapy Association. Low back pain clinical care standard. https://australian.physio/research/prf/translation/low-back-pain-clinical-care-standard. Accessed 4th September 2024.
2. Bugeja, B. (2024). WalkBack trial for low back pain. Australian Physiotherapy Association.  https://australian.physio/inmotion/walkback-trial-low-back-pain
3. Cieza, A., Causey, K., Kamenov, K., Hanson, S. W., Chatterji, S., & Vos, T. (2020). 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, 396(10267), 2006-2017.
4. Ferreira, M. L., De Luca, K., Haile, L. M., Steinmetz, J. D., Culbreth, G. T., Cross, M., ... & Mahmoodpoor, A. (2023). Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. The Lancet Rheumatology, 5(6), e316-e329.Hill, J. C., Whitehurst, D. G., Lewis, M., Bryan, S., Dunn, K. M., Foster, N. E., ... & Hay, E. M. (2011). Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. The Lancet, 378(9802), 1560-1571.
5. Kent, P., Haines, T., O'Sullivan, P., Smith, A., Campbell, A., Schutze, R., ... & Hancock, M. (2023). Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial. The Lancet, 401(10391), 1866-1877.
6. Kosakowski, H., Rone-Adams, S., Boissonnault, W. G., Harmon-Matthews, L., Kuczynski, J. J., Martin, M., & Briggs, M. S. (2024). Financial impact associated with implementation of the low back pain clinical practice guideline in outpatient physical therapist practice at a large academic medical center. Physiotherapy Theory and Practice, 40(4), 746-754.
7. Maher, C., Underwood, M., & Buchbinder, R. (2017). Non-specific low back pain. The Lancet, 389(10070), 736-747.
8. National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. https://www.nice.org.uk/guidance/ng59. Accessed 4th September 2024.
9. O'Keeffe, M., O'Sullivan, P., Purtill, H., Bargary, N., & O'Sullivan, K. (2020). Cognitive functional therapy compared with a group-based exercise and education intervention for chronic low back pain: a multicentre randomised controlled trial (RCT). British journal of sports medicine, 54(13), 782-789.
10. Sharma, S., & McAuley, J. H. (2022). Low back pain in low-and middle-income countries, part 1: the problem. journal of orthopaedic & sports physical therapy, 52(5), 233-235.
11. Sharma, S., Pathak, A., Parker, R., Costa, L. O. P., Ghai, B., Igwesi-Chidobe, C., ... & McAuley, J. H. (2024). How Low Back Pain is Managed—A Mixed-Methods Study in 32 Countries. Part 2 of Low Back Pain in Low-and Middle-Income Countries Series. journal of orthopaedic & sports physical therapy, 54(8), 560-572.
12. STarT Back Screening Tool, Keele University.
13. The Global Epidemic of low back pain. The Lancet Rheumatology. June 2023. DOI: 10.1016/S2665-9913(23)00133-9
14. Vibe Fersum, K., O'Sullivan, P., Skouen, J. S., Smith, A., & Kvåle, A. (2013). Efficacy of classification‐based cognitive functional therapy in patients with non‐specific chronic low back pain: A randomized controlled trial. European journal of pain, 17(6), 916-928.
15. Wewege, M. A., Bagg, M. K., Jones, M. D., Ferraro, M. C., Cashin, A. G., Rizzo, R. R., ... & McAuley, J. H. (2023). Comparative effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain: systematic review and network meta-analysis. Bmj, 380.
16. World Health Organization. (2023). WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. World Health Organization.