Referral of people with low back pain to physical therapists in Brazilian primary healthcare: A challenge revealed.

The study relied on secondary data from electronic health records, which contained incomplete information, such as missing procedure codes and unknown patient sex or education levels. The dataset did not include detailed clinical information, making it impossible to determine if patients had red flags or radiating pain that might justify specialist or imaging referrals. The study could not identify actions taken by nurses or other allied health professionals due to insufficient data. Delays in referral timing may have been influenced by waiting lists or new episodes of pain unrelated to the initial consultation, which the data could not distinguish.

The study was supported by the Research Support Foundation of the Federal District (FAPDF) and the Coordination for the Improvement of Higher Education Personnel (CAPES). The authors declare no competing interests.

Do not interpret the low referral rates as evidence that physical therapy is ineffective or unnecessary. The study reflects systemic barriers in the Brazilian healthcare system, such as administrative flows and policy structures, rather than clinical outcomes or patient preferences.