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Interventions That Increase or Decrease the Likelihood of a Meaningful Improvement in Physical Health in Patients With Sciatica

DV Jewell, PT, PhD, CCS, FAACVPR, is Assistant Professor, Department of Physical Therapy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298-0224 (USA) (dvjewell{at}vcu.edu)
DL Riddle, PT, PhD, FAPTA, is Professor, Department of Physical Therapy, Virginia Commonwealth University, Medical College of Virginia Campus

Address all correspondence to Dr Jewell

Background and Purpose. The purpose of our study was to determine whether physical therapy interventions predicted meaningful short-term improvement in physical health for patients diagnosed with sciatica. Subjects. We examined data from 1,804 patients (age: =52.1 years, SD=15.6 years; 65.7% female, 34.3% male) who had been diagnosed with sciatica and who had completed an episode of outpatient physical therapy. Methods. Principal components factor analysis was used to define intervention categories from specific treatments applied during the plan of care. A nested-model logistic regression analysis identified intervention categories that predicted meaningful improvement in physical health. Meaningful improvement was defined as a change of 14 or more points on the Physical Component Scale-12 (PCS-12) summary score. Results. Twenty-six percent (n=473) of patients had a meaningful improvement in physical health. Improvement was more likely in patients receiving joint mobility interventions (odds ratio [OR]=2.5, 95% confidence interval [CI]=1.5–4.4) or general exercise (OR=1.5, 95% CI=1.2–2.0). Patients who received spasm reduction interventions were less likely to improve (OR=0.77, 95% CI=0.60–0.98). Discussion and Conclusion. Physical therapists should emphasize the use of joint mobility interventions and exercise when treating patients with sciatica, whereas interventions for spasm reduction should be avoided.

Key Words: Back pain • Exercise • Health status • Joints • Outcome assessment • Sciatica