The physiotherapy management of lumbar radicular syndrome; Does early intervention improve outcomes?

Lumbar radiucular syndrome (LRS) carries a significant individual and societal burden. It is often associated with low back pain but is distinct in its presentation, effects and symptom duration. There are varied treatment options for the manangement of LRS, but the optimal timing of interventions is significanlty under-researched. This is a problem for patients suffering with LRS, but also clinicans and service commisioners as it is unclear when it is best to instigate different treatments for LRS.
This PhD aimed to determine the feasibility of undertaking an RCT to determine the effectiveness and cost-effectiveness of early physiotherapy compared to usual care for LRS.
A sytematic review was carried out to determine the optimal timing of commonly used interventions for LRS such as physiotherapy and surgery. From an initial screening of 330 eligible articles, only four studies met the eligibility criteria. Three of the articles were from one study, the original study and two follow-up papers. The results found there was insufficent evidence to suggest the optimal timing of any interventions commonly used for LRS.
The findings of the systematic review provided the foundations for the POLAR mixed methods study, comprising of an external pilot study, stakeholder interviews and a preliminary economic evaluation. 80 participants were recruited in 10 GP practices over 34 weeks, within time and randomised to usual care (n=38) or early intervention physiotherapy within 2 weeks of randomisation (n=42). Both groups received the same individualised physiotherapy approach of up to six treatment sessions over an 8-week period..
All feasibility objectives were achieved including recruitment, attrition and intervention delivery and fidelity. The mean area under the curve (larger values indicating more disability) for the Oswestry Disability Index over the 26 weeks was 16.6 (SD 11.4) in the usual care group and 16.0 (SD 14.0) in the intervention group. A difference of −0.6 (95% CI −0.68 to 5.6) in favour of the intervention group.
Feedback from participants (n=33) through 45 interviews found acceptance of the study processes and intervention. Furthermore, key themes emerged as to participant experiences of LRS and management which will aid future intervention development and research.
The findings from this mixed methods PhD suggest that a full RCT is feasible, within a reasonable time scale and resource envelope in order to determine the optimal timing of physiotherapy for LRS.