Real-world Physiotherapy Use After Non-specific Low Back Pain And Its Effect On Sick Leave Utilisation

Abstract

Aim: The aim of this study was to describe one year real-world physiotherapy (PT) use and sick leave taking after initial non-specific low back pain (NSLBP) episode in Estonia, and analyse the effect of PT on sick leave use. Methods: This is a retrospective cohort study using population-based healthcare data received from the Estonian Health Insurance Fund (EHIF). Patients ≥ 18 years old and with a primary NSLBP diagnosis between January 2014 and December 2023 were included. Specific analysis on PT and sick leave utilisation is based on the Landmark target trial emulation (TTE) design. Results: The study included a total of 175,409 patients, of which 6,051 were included in the TTE. 22.1% of the total, 21.3% of the employed and 29,0% of the TTE cohort received PT. Sick leave was taken by 28.4% of the total and 4.5% of the TTE cohort. The median PT volume in the total population was 3 (Q1-Q3: 1.5-5.0) hours with the median initiation time of 63 (Q1-Q3: 21-147) days. PT recipients had 1.4 percentage points lower (95% CI: 0.32; 2.42) probability for sick leave, but 24.8 days longer (95% CI: 8.5; 49.7) duration. However, when looking at the overall expected sick leave days, the PT group showed similar results to the no-PT group, meaning the effect size was 0.4 days (95% CI: -0.2; 1.4). Conclusions: Despite clinical practice guidelines recommending PT in the management of NSLBP, PT stays rather poorly accessible in Estonia. PT has no effect on the total number of sick leave days taken due to NSLBP. Therefore, a standardised approach may be needed for better comprehensive management of NSLBP.