What standard can be used to know that physiotherapy services are a good thing?

I’ve seen multiple debates online about the effectiveness of services. Some believe that tracking outcomes does not prove effectiveness. Often times these individuals focus on the fact that a randomized controlled trial didn’t happen in the clinic – which means the natural course of the condition is not taken into account.

This recent study is interesting because it sort of answers the question of when physiotherapy is worthwhile – meaning the service provides benefit that exceeds the natural course of the condition. This is relevant to know when considering the cost of services and the time and effort involved to attain the desired outcome.

When compared to the natural course of a condition, once physiotherapy services hit a reduction in pain and an increase in function 20% above the natural course of the condition, the services are considered worthwhile.

You’ll find the abstract to the recent study below.

The smallest worthwhile effect of primary care physiotherapy did not differ across musculoskeletal pain sites.

Christiansen DH¹, de Vos Andersen NB², Poulsen PH³, Ostelo RW⁴.

Abstract

OBJECTIVES:

To determine and compare estimates of the smallest worthwhile effect (SWE) for physiotherapy in neck, shoulder and low back patients, and to investigate the influence of socio-demographic, clinical and psychological factors on these estimates.

METHODS:

A structured telephone interview was conducted before treatment was commenced in 160 patients referred for primary care physiotherapy. The benefit-harm trade-off method was used to estimate the SWE of physiotherapy for the following outcomes; pain, disability and time to recovery, compared with the improvement achieved without any treatment (natural course). Regression analyses were used to assess the influence of socio-demographics, clinical variables and intake scores on pain, disability and psychological scales.

RESULTS:

The median SWE for improvements on pain and disability was 20% (interquartile range [IQR] 10-30%) and the SWE for time to recovery was 10 days (IQR 7-14 days) over a period of six weeks. These estimates did not differ with respect to pain location (neck, shoulder or back) and were generally unaffected by socio-demographic, clinical and psychological factors.

CONCLUSION:

People with neck, shoulder and low back pain need to see at least 20% of additional improvement on pain and disability compared with natural recovery to consider that the effect of physiotherapy is worthwhile, given its costs, potential side effects and inconveniences.

J Clin Epidemiol. 2018 May 28. pii: S0895-4356(17)31379-3. doi: 10.1016/j.jclinepi.2018.05.019. [Epub ahead of print]