Physiotherapy for low back pain: differences between public and private healthcare sectors in Ireland--a retrospective survey.

Objectives: European clinical guidelines for low back pain (LBP) recommend early referral of appropriate patients to health services such as physiotherapy. The current study aimed to investigate any differences between the physiotherapy management of LBP, and the physiotherapist and patient profiles in public and private health settings in Ireland.

Design: A retrospective chart survey of all LBP patients referred for physiotherapy to one Dublin City hospital and three neighbouring private practices in 2003 was conducted.

Results: In total, 249 physiotherapy charts (hospital [H] n=93; private practice [Pr] n=156) were identified and demographic, LBP, and management details analysed. Only charts containing full LBP duration and physiotherapy treatment data were included in the analysis of these parameters (LBP duration: H=84, Pr=130; physiotherapy treatment: H=79, Pr=155). There were significantly higher percentages of female (H=66%; Pr=50%: p=0.017), older (H=46 years; Pr=36 years: p<0.001), and chronic LBP patients (>12 weeks; H=50%; Pr=2%: p<0.001) in the public setting. Public patients had significantly longer waiting times for physiotherapy (median H=10 weeks; Pr=0; p<0.001), and more treatment (H=5.1; Pr=2.5: p0.001) than private patients. While treatment approaches were similar for both settings, there was a significantly higher use of advice and spinal stabilisation exercises in the public setting. However, there was minimal difference in the management of acute or chronic LBP in both setting suggesting poor adherence to European guidelines.

Conclusions: Findings showed longer waiting times, and a higher number and duration of physiotherapy treatments for acute and chronic LBP in the public setting suggesting the need to develop publicly funded primary healthcare in Ireland.