Evidence map›Paper›PMID 33351942›Full record

Observational studyPhysical therapy2021

A Prospective Observational Study of Emergency Department-Initiated Physical Therapy for Acute Low Back Pain.

Howard S Kim, Jody D Ciolino, Nicola Lancki, Kyle J Strickland, Daniel Pinto, Christine Stankiewicz, D Mark Courtney, Bruce L Lambert, Danielle M McCarthy

Open access · bronzeAbstract readComparative StudyObservational Study
In one paragraph

Observational study in Physical therapy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 1 pooled it
1.5field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Team-based, Multidisciplinary Care in the Emergency Department.Emergency medicine clinics of North America · 2025
    Review
  5. Article
  6. Article
  7. Article
  8. Review
  9. Sciatica. Management for family physicians.Journal of family medicine and primary care · 2022
    Review
  10. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 1 country.

Howard S KimDepartment of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Jody D CiolinoDivision of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Nicola LanckiDivision of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Kyle J StricklandDepartment of Rehabilitation Services, Northwestern Memorial Hospital, Chicago, Illinois, USA.
Daniel PintoDepartment of Physical Therapy, Marquette University College of Health Sciences, Milwaukee, Wisconsin, USA.
Christine StankiewiczDepartment of Rehabilitation Services, Northwestern Memorial Hospital, Chicago, Illinois, USA.
D Mark CourtneyDepartment of Emergency Medicine, University of Texas Southwestern Medical School, Dallas, Texas, USA.
Bruce L LambertDepartment of Communication Studies, Center for Communication and Health, Northwestern University School of Communication, Chicago, Illinois, USA.
Danielle M McCarthyDepartment of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Northwestern University · USNorthwestern Memorial Hospital · USMarquette University · USThe University of Texas Southwestern Medical Center · US

Funding

Northwestern University Clinical and Translational Science Institute (NUCATS)UL1TR001422 · NCATS · NORTHWESTERN UNIVERSITY AT CHICAGO · PI D'AQUILA, RICHARD · 2015 to 2023
$56.8M
Rodent Behavior CoreP50DA044121 · NIDA · NORTHWESTERN UNIVERSITY AT CHICAGO · PI BALIKI, MARWAN N · 2018 to 2022
$9.0M
Northwestern University Patient-centered Intervention and Engagement TrainingK12HS023011 · AHRQ · NORTHWESTERN UNIVERSITY AT CHICAGO · PI CELLA, DAVID · 2014 to 2018
$3.7M
AHRQ HHS K12 HS023011NCATS NIH HHS UL1 TR001422NIDA NIH HHS P50 DA044121
6 · The paper itself

Abstract

objectiveLow back pain accounts for nearly 4 million emergency department (ED) visits annually and is a significant source of disability. Physical therapy has been suggested as a potentially effective nonopioid treatment for low back pain; however, no studies to our knowledge have yet evaluated the emerging resource of ED-initiated physical therapy. The study objective was to compare patient-reported outcomes in patients receiving ED-initiated physical therapy and patients receiving usual care for acute low back pain.

methodsThis was a prospective observational study of ED patients receiving either physical therapy or usual care for acute low back pain from May 1, 2018, to May 24, 2019, at a single academic ED (>91,000 annual visits). The primary outcome was pain-related functioning, assessed with Oswestry Disability Index (ODI) and Patient-Reported Outcomes Measurement Information System pain interference (PROMIS-PI) scores. The secondary outcome was use of high-risk medications (opioids, benzodiazepines, and skeletal muscle relaxants). Outcomes were compared over 3 months using adjusted linear mixed and generalized estimating equation models.

resultsFor 101 participants (43 receiving ED-initiated physical therapy and 58 receiving usual care), the median age was 40.5 years and 59% were women. Baseline outcome scores in the ED-initiated physical therapy group were higher than those in the usual care group (ODI = 51.1 vs 36.0; PROMIS-PI = 67.6 vs 62.7). Patients receiving ED-initiated physical therapy had greater improvements in both ODI and PROMIS-PI scores at the 3-month follow-up (ODI = -14.4 [95% CI = -23.0 to -5.7]; PROMIS-PI = -5.1 [95% CI = -9.9 to -0.4]) and lower use of high-risk medications (odds ratio = 0.05 [95% CI = 0.01 to 0.58]).

conclusionIn this single-center observational study, ED-initiated physical therapy for acute low back pain was associated with improvements in functioning and lower use of high-risk medications compared with usual care; the causality of these relationships remains to be explored. IMPACT: ED-initiated physical therapy is a promising therapy for acute low back pain that may reduce reliance on high-risk medications while improving patient-reported outcomes. LAY SUMMARY: Emergency department-initiated physical therapy for low back pain was associated with greater improvement in functioning and lower use of high-risk medications over 3 months.

Indexed as

Emergency Service, HospitalPhysical Therapy ModalitiesAcute PainAdultDisability EvaluationFemaleHealth Services AccessibilityHumansLow Back PainMaleMiddle AgedPatient Reported Outcome MeasuresProspective StudiesAcute CareAcute PainAnalgesicsBack PainEmergency Care

Identifiers

PMID33351942
PMCPMC7970627
OpenAlexW3116174880

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.