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

Only 362 patients had complete physical therapy utilisation information and were analysed. The comparison was not randomized; patients chose or were assigned to non-surgical care in the larger study, and physical therapy was not assigned randomly. There is risk of selection bias and unidentified confounders between the groups. Physical therapy was not standardized, and specific dose, content, and provider details were not reported. Patients received other treatments at the same time, including medications, injections, education, and home exercise, so the effect of physical therapy alone cannot be separated. Outcomes were analysed only for patients continuing non-surgical management, and patients who progressed to surgery were censored from later analyses. People with prior lumbar surgery, cauda equina syndrome, scoliosis greater than 15°, instability, fractures, non-musculoskeletal spine conditions, pregnancy, or inability or unwillingness to have surgery were excluded.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases, the Office of Research on Women’s Health, the National Institutes of Health, the National Institute of Occupational Safety and Health, and the Centers for Disease Control and Prevention provided funding. The authors reported no competing interests and no direct financial benefit.

Do not conclude that physical therapy is ineffective for sciatica from a herniated lumbar disc. These patients were not randomly assigned to physical therapy, the therapy was not standardized, and many received other treatments such as medications and injections at the same time.