Early Referral to Physical Therapy: A Reasonable Choice for Primary Care Patients With Sciatica
Authors: Nadine E. Foster, Michael Reddington
Journal: Annals of Internal Medicine (2020)

EditorialsJanuary 2021Early Referral to Physical Therapy: A Reasonable Choice for Primary Care Patients With SciaticaNadine E. Foster, DPhil and Michael Reddington, PhDNadine E. Foster, DPhilSchool of Primary, Community and Social Care, Keele University, Keele, United Kingdom (N.E.F.) and Michael Reddington, PhDSchool of Health and Related Research, University of Sheffield, Sheffield, United Kingdom (M.R.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-6545 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Sciatica involves pain that radiates down the leg, often with a sharp, shooting or burning quality, usually due to disk herniation. Although common in primary care, the evidence to inform clinical decisions in this setting is limited; most studies are done in hospital settings or specialist spine centers. Some patients recover without much treatment, whereas others form distinct clusters with high levels of pain and disability (1, 2). Some patients may benefit from conservative management, such as physical therapy, or from consideration of more invasive treatments, such as injection therapy or disk surgery. However, decision making about early referral is ...References1. Ogollah RO, Konstantinou K, Stynes S, et al. Determining one-year trajectories of low-back-related leg pain in primary care patients: growth mixture modeling of a prospective cohort study. Arthritis Care Res (Hoboken). 2018;70:1840-1848. [PMID: 29575673] doi:10.1002/acr.23556 CrossrefMedlineGoogle Scholar2. Stynes S, Grøvle L, Haugen AJ, et al. New insight to the characteristics and clinical course of clusters of patients with imaging confirmed disc-related sciatica. Eur J Pain. 2020;24:171-181. [PMID: 31454467] doi:10.1002/ejp.1475 CrossrefMedlineGoogle Scholar3. Lewis RA, Williams NH, Sutton AJ, et al. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine J. 2015;15:1461-77. [PMID: 24412033] doi:10.1016/j.spinee.2013.08.049 CrossrefMedlineGoogle Scholar4. El Barzouhi A, Verwoerd AJ, Peul WC, et al; Leiden–The Hague Spine Intervention Prognostic Study Group. Prognostic value of magnetic resonance imaging findings in patients with sciatica. J Neurosurg Spine. 2016;24:978-85. [PMID: 26871651] doi:10.3171/2015.10.SPINE15858 CrossrefMedlineGoogle Scholar5. Lewis R, Williams N, Matar HE, et al. The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model. Health Technol Assess. 2011;15:1-578. [PMID: 22078311] doi:10.3310/hta15390 CrossrefMedlineGoogle Scholar6. Konstantinou K, Lewis M, Dunn KM, et al. Stratified care versus usual care for management of patients presenting with sciatica in primary care (SCOPiC): a randomised controlled trial. Lancet Rheumatol. 2020;2:e401-e411. [PMID: 32617529] doi:10.1016/S2665-9913(20)30099-0 CrossrefMedlineGoogle Scholar7. Konstantinou K, Dunn KM, Ogollah R, et al; ATLAS Study Team. Prognosis of sciatica and back-related leg pain in primary care: the ATLAS cohort. Spine J. 2018;18:1030-1040. [PMID: 29174459] doi:10.1016/j.spinee.2017.10.071 CrossrefMedlineGoogle Scholar8. Fritz JM, Lane E, McFadden M, et al. Physical therapy referral from primary care for acute back pain with sciatica. A randomized controlled trial. Ann Intern Med. 2021;174:8-17. doi:10.7326/M20-4187 LinkGoogle Scholar9. Moffatt F, Goodwin R, Hendrick P. Physiotherapy-as-first-point-of-contact-service for patients with musculoskeletal complaints: understanding the challenges of implementation. Prim Health Care Res Dev. 2018;19:121-130. [PMID: 28893343] doi:10.1017/S1463423617000615 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: School of Primary, Community and Social Care, Keele University, Keele, United Kingdom (N.E.F.)School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom (M.R.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-6545.Corresponding Author: Nadine E. Foster, DPhil, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, David Weatherall Building, Keele University, Keele, ST5 5BG United Kingdom; e-mail, n.[email protected]ac.uk.Current Author Addresses: Prof. Foster: School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, David Weatherall Building, Keele University, Keele, ST5 5BG United Kingdom.Dr. Reddington: School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA United Kingdom.This article was published at Annals.org on 6 October 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPhysical Therapy Referral From Primary Care for Acute Back Pain With Sciatica Julie M. Fritz , Elizabeth Lane , Molly McFadden , Gerard Brennan , John S. Magel , Anne Thackeray , Kate Minick , Whitney Meier , and Tom Greene Metrics Cited byIdentifying the neural marker of chronic sciatica using multimodal neuroimaging and machine learning analysesThe study on the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of nerve root sciatica January 2021Volume 174, Issue 1Page: 107-108KeywordsDecision makingDisabilitiesExerciseExercise therapyHealth careMagnetic resonance imagingPatientsRandomized trialsSpineSurgery ePublished: 6 October 2020 Issue Published: January 2021 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...