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Title:  Physiotherapy plus general practitioners’ care more effective than general practitioners’care alone in patients with sciatica? 1-year results of a randomised clinical trial.

Authors and affiliation: Pim A.J. Luijsterburg1, MSc, Arianne P. Verhagen1, PhD, Raymond W.J.G. Ostelo2,3, PhD, Hans J.M.M. van den Hoogen4, PhD, MD, Wilco C. Peul5,6, PhD, MD, Cees J.J. Avezaat7, PhD, MD, Bart W. Koes1, PhD

1 General Practice, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
2: Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, the Netherlands
3: Amsterdam School of Allied Health Education, Amsterdam, the Netherlands
4: General Practice, Asten, the Netherlands
5: Neurosurgery, Leids University Medical Center, Leiden, the Netherlands
6: Neurosurgery, Medical Center Haaglanden, the Hague, the Netherlands
7: Neurosurgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands

Email address: pimluijsterburg@hotmail.com

Objective To assess the effectiveness of physical therapy additional to general practitioners’ care compared to general practitioners’ care alone, in patients with acute sciatica.

Design, setting and patients A randomised clinical trial in primary care with a 12-months follow-up period. 135 patients with acute sciatica (recruited from May 2003 to November 2004) were randomised in two groups: 1) the intervention group received physical therapy added to the general practitioners’ care, and 2) the control group with general practitioners’ care only.

Intervention Physical therapy consisting of active exercises added to general practitioners’ care.

Main outcome measures The primary outcome was patients’ global perceived effect. Secondary outcomes were severity of leg and back pain, severity of disability, general health and absence from work. The outcomes were measured at 3, 6, 12 and 52 weeks after randomisation.

Results At 3 months follow-up, 70% of the intervention group and 62% of the control group reported improvement (RR 1.1; 95% CI 0.9 to 1.5). At 12 months follow-up, 79% of the intervention group and 56% of the control group reported improvement (RR 1.4; 95% CI 1.1; 1.8). No significant differences in secondary outcomes were found at short-term or long-term follow-up.

Conclusion At 12 months follow-up, evidence was found that physical therapy added to general practitioners’ care is more effective in the treatment of patients with acute sciatica than general practitioners’ care alone. There are indications that physical therapy is especially effective in patients reporting severe disability at presentation.

Trial registration An International Standard Randomised Controlled Trial Number was assigned to this trial (ISRCTN68857256) at www.controlled-trials.com