A total of 169 patients aged 50-plus already headed for
decompression surgery agreed to be randomly assigned into two groups:
Those who would have the procedure, and those who went through two
standardized, evidence-based physical therapy sessions per week for six
weeks. After both groups were re-examined at intervals of six months,
one year and two years, the patient outcomes appeared to be equal. There
were no detectable differences between the groups in how their pain
abated and the degree to which function was restored in their backs,
buttocks and legs.
“Probably the biggest point to put across to physicians, patients
and practitioners is: Patients don’t exhaust all of their non-surgical
options before they consent to surgery. And physical therapy is one of
their non-surgical options,” said principal investigator Anthony Delitto, Ph.D., chair of the Department of Physical Therapy, Pitt School of Health and Rehabilitation Sciences (SHRS), as well as a member of Pitt’s Health Policy Institute (HPI) and a consultant to UPMC.
Dr. Delitto, a physical therapist, and his SHRS colleagues have
long puzzled over why some patients reacted well to physical therapy
(PT) and others to surgery.
“The idea we had was to really test the two approaches head to
head,” he said. “Both groups improved, and they improved to the same
degree. Now, embedded in that, there are patients who did well in
surgery, and patients who failed in surgery. There are patients who did
well in PT, and there are patients who failed with PT. But when we
looked across the board at all of those groups, their success and
failure rates were about the same.”
The research project also revealed issues surrounding PT
appointments and the cost of co-pay, which may prove enlightening to
policymakers enmeshed in the charged atmosphere around health care, Dr.
Delitto added.
Most patients didn’t finish the PT regimen allowed them under
Medicare and prescribed by the researchers, and one-third of the
patients failed to complete even half of the regimen. Another 16 percent
didn’t show for a single treatment, though they had agreed to consider
PT.
“One of the big things that we know held patients back from PT were
co-payments,” Dr. Delitto added. “Patients were on Medicare, and a lot
of them were on fixed incomes. Some of those co-payments had to come out
of pocket at $25, $30, $35 per visit. That adds up, and some of the
patients just couldn’t afford it.”