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Am J Phys Med Rehabil. 2017 Aug;96(8):557-564. doi: 10.1097/PHM.0000000000000685.

Nonsurgical Treatment Choices by Individuals with Lumbar Intervertebral Disc Herniation in the United States: Associations with Long-term Outcomes.

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From the Department of Physical Therapy, University of Utah, Salt Lake City (AT, JMF); Intermountain Health Care, Salt Lake City, Utah (JMF); Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire (JDL, JNW); The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire (JDL, WZ, JNW); Department of Orthopaedics, Dartmouth Medical School, Hanover, New Hampshire (WZ, JNW); and Dartmouth-Hitchcock, Lebanon, New Hampshire (JNW).



The objectives of this study were to (1) evaluate differences between patients with lumbar intervertebral disc herniation who received physical therapy (PT) and those who did not; (2) identify factors associated with receiving PT; and (3) examine the influence of PT on clinical outcomes over the course of 1 yr.


An observational cohort study using data from the Spine Patient Outcomes Research Trial was conducted. This study included 363 patients with intervertebral disc herniation who received nonsurgical management within 6 wks of enrollment. Baseline characteristics were compared between patients who received PT and those who did not. Multivariate logistic regression examined factors predictive of patients receiving PT. Mixed effects models were used to compare primary outcomes (Short-Form Survey 36 bodily pain and physical function and modified Oswestry Index) at 3 and 6 mos and 1 yr after enrollment.


Forty percent of the nonsurgical cohort received PT. Higher disability scores, neurological deficit, and patient preference predicted PT use. Compared with other nonsurgical management strategies, standard care PT was not associated with a significant difference in pain, disability, or surgery over 1 yr.


Many patients with intervertebral disc herniation seek secondary care for persisting symptoms and pursue nonsurgical management. The best management strategy is unclear and further research is needed to examine appropriate sequencing and selection of treatment.

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