Following work-related low back injury, patients with chronic, nonspecific low back pain showed greater improvement in short-term outcomes with orthotic treatment and usual care compared with usual care alone, according to a recently published study.

“As chronic low back pain following reported low back injury at work is a common clinical problem, associated with work-related disability and increased health care utilization, there is a need to determine if customized foot orthotics are effective in this clinical group,” Robert Ferrari, MD, MSc(Med), FRCPC, FACP, clinical professor in the Department of Medicine and Department of Rheumatology at the University of Alberta, Edmonton, Alberta, Canada, wrote. “The objective of this study was to compare the effect of customized foot orthotics in addition to usual care compared with usual care along for the treatment of patients with chronic low back pain after work-related injury.”

Robert Ferrari

Robert Ferrari

Orthoses vs. usual care

Twenty-eight patients were assigned to a usual care group and 32 patients to an orthoses group; all presented with chronic, nonspecific, low back pain following work-related low back injury. Patients in the usual care group were given a 6-week exercise therapy program along with prescription analgesics, whereas the orthoses group received usual care in addition to customized foot orthoses. All patients completed the Oswestry Disability Index at baseline and at 8-week follow-up, when work disability, defined by working at usual, preinjury job labor level, was also recorded.

Overall, both groups had improved at 8 weeks. Although the two groups were well matched in terms of age, sex distribution and duration of low back pain as well as baseline Oswestry Disability Index score, the orthoses group had a lower Oswestry Disability Index at 8 weeks vs. the usual care group. Additionally, a smaller proportion of the orthoses group used prescribed analgesics for back pain.

“The need for fewer analgesics [in the orthotics group] was impressive,” Ferrari told O&P Business News. “Compared to a cohort of usual care, patients with chronic low back pain following work-related injury appear to improve more with the addition of customized foot orthotics to usual care. The addition of orthotics to usual care will likely get patients back to good health and back to work sooner, and will reduce their need for analgesics.”

Study limitations

Researchers said the study was limited because it was underpowered and was not a randomized, controlled study. Primary care physicians and the treating exercise therapist may have treated patients differently after learning about the patients’ use of orthoses, which may have affected outcomes. Finally, Ferrari said it is not possible to create a placebo control for foot orthoses and much of the response from patients could be due to a placebo effect, which could also be a factor in exercise therapy and medication.

According to Ferrari, future studies should include a larger number of patients in a variety of clinical settings. They should also quantify cost-effectiveness, Ferrari said, which could lead to preferred intervention for patients, especially if orthotic treatment leads to similar outcomes as usual care, but costs less. Additionally, enrolling participants who seek other therapy to relieve their back pain would be beneficial because “it is likely that orthotics will be used in the setting of multiple therapy approaches, and studies will thus need to be carried out in this setting to be clinically relevant in practice,” he said.

“Given the innocuous nature of the orthotics, compared with medications, and the ease with which they may be provided, their use in clinical practice should be further considered both for patient convenience and possibly for cost-effectiveness, if they reduce the need for other therapies,” Ferrari said. — by Casey Murphy

For more information:
Ferrari R. J Manipulative Physiol Ther. 2013;doi:10.1016/j.jmpt.2013.06.002

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