Exercise underutilized for chronic back and neck pain

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Exercise underutilized for chronic back and neck pain

http://www.eurekalert.org/pub_releases/2009-01/w-euf012909.php

Studies suggest that individually tailored, supervised exercise

programs are associated with minimizing disabilities

Exercise is commonly used to improve physical function, decrease

symptoms and minimize disability caused by chronic low back or neck

pain. Numerous randomized trials and clinical practice guidelines

have supported this practice, and studies suggest that individually

tailored, supervised exercise programs are associated with the best

outcomes.

Nevertheless, there is a lack of knowledge about exercise

prescription, including who is prescribing it, who is getting it and

what type of exercise is being prescribed. A new study, funded by the

National Institutes of Health, examined these questions and found

that exercise may be underutilized for chronic back and neck pain.

The study was published in the February issue of Arthritis Care &

Research (http://www3.interscience.wiley.com/journal/77005015/home).

Led by S. Carey and Janet K. Freburger of the Cecil G. Sheps

Center for Health Services Research at the University of North

Carolina at Chapel Hill, researchers conducted a telephone survey of

almost 700 individuals with chronic back or neck pain who saw a

physician, chiropractor and/or physical therapist (PT) during the

previous 12 months. They asked participants whether they were

prescribed exercise, the amount of supervision received, and the

type, duration and frequency of the prescribed exercise.

" Less than 50 percent of the subjects in our sample were prescribed

exercise, one of the few moderately effective therapies for the

highly disabling illness of chronic back and neck pain, " the authors

state. The type of provider seen played a major role in whether

participants received a prescription. Of those who received exercise

prescription, 46 percent received the prescription from a PT, 27

percent from a physician, and 21 percent from a chiropractor. The

authors note that these findings agree with previous studies that

have found that " who you see is what you get. "

Although most of the 700 participants had seen a physician, only 14

percent were prescribed exercise. Some of those who were not

prescribed exercise by a physician, however, were likely referred to

a PT who did prescribe exercise. Not surprisingly, Pts were the most

likely to prescribe exercise, although about a third of those who saw

a PT did not receive an exercise prescription.

For those who were prescribed exercise, the type of provider seen

determined the amount of supervision and, to some extent, the types

of exercises prescribed. Pts were more likely to provide supervision

and prescribe stretching and strengthening exercises, practices which

follow current guidelines and lead to better outcomes.

" Considering current evidence on the efficacy of exercise, these

findings demonstrate that exercise is being underutilized as a

treatment for chronic back and neck pain, " the authors state. They

note that none of the hypothesized health-related characteristics,

such as pain or weakness in the extremities, hypothesized whether an

individual was prescribed exercise and that providers' decisions to

prescribe exercise did not appear to be influenced by the degree of

impairment. However, women, people with a higher education level and

those receiving worker's compensation were more likely to be

prescribed exercise. This may be because women and more educated

individuals are more likely to be active participants in their care

and those with worker's compensation are frequently injured on the

job and treated with the goal of returning to work.

" Although exercise prescription provided by Pts appears to be the

most in line with current guidelines, there is much room for

improvement by all types of providers who prescribe exercise for

patients with chronic back and neck pain, " the authors note. They

suggest that future studies should explore barriers to prescription

of exercise treatments, such as practitioner knowledge,

organizational aspects of the practice, and poor reimbursement for

exercise instruction compared with other types of treatment.