Is One Enough? The Effectiveness of a Single Session of Education and Exercise Compared to Multiple Sessions of a Multimodal Physiotherapy Intervention for Adults With Spinal Disorders in an Advanced Practice Physiotherapy Model of Care: A Randomised Controlled Trial

Abstract

OBJECTIVE: To assess the effectiveness of a single session of education and exercise compared with multiple sessions of a multimodal physiotherapy intervention for adults with spinal disorders in an advanced practice physiotherapy specialized spine model of care. DESIGN: Pragmatic randomized controlled trial. METHODS: We randomized patients with spinal disorders, who were referred for a spinal surgery consultation and triaged as non-surgical cases by an advanced practice physiotherapist, to a single session of education and prescription of an exercise program (n=52) or multiple sessions (6 in total) of a multimodal physiotherapy intervention (n=54). The primary outcomes were the short form Brief Pain Inventory Severity (BPI-S) and Interference (BPI-I) scales and secondary outcomes included disability, quality of life, catastrophization, and satisfaction. Linear mixed models were used to assess differences between-groups across time points at 6, 12 and 26 weeks. RESULTS: There were no significant between-group differences on the BPI-S and only a significant improvement at 6 weeks on the BPI-I in the multiple-session group (mean difference: -0.96/10; 95%CI: -1.87 to -0.05). There were no other statistically significant differences between groups, except for satisfaction where participants in the multiple-session group reported statistically significantly greater satisfaction on the VSQ-9 and Medrisk questionnaires. Both groups saw significant improvements over time on all outcomes except for the BPI-S. CONCLUSIONS: Adding supervised multimodal physiotherapy sessions did not result in better clinical outcomes when compared to a single session of education and exercise. Patients were more satisfied with the multiple session approach.