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

## TL;DR

In Brazil, very few people with low back pain are referred to physical therapists, and those who are face long wait times before seeing them.

## Contribution

This study reveals low referral rates and long delays in accessing physical therapy for low back pain in Brazilian primary healthcare.

## Key findings

- Only 1% of people with low back pain were referred to physical therapists.
- The time between referral and seeing a physical therapist ranged from 17 to 261 days.
- Imaging and specialist referrals were common, with 8.9% of participants referred for imaging.

## Abstract

•From a national primary care perspective, around 1 % of people with LBP were referred to physical therapy.•The amount of time between referral and being seen by physical therapists ranged from 17 to 261 days.•The overall rate of physical therapy visits to manage LBP was 1.28 per 1000 people.

From a national primary care perspective, around 1 % of people with LBP were referred to physical therapy.

The amount of time between referral and being seen by physical therapists ranged from 17 to 261 days.

The overall rate of physical therapy visits to manage LBP was 1.28 per 1000 people.

Low back pain (LBP) is a disabling condition worldwide, and current evidence suggests low rates of referral to physical therapists and extensive use of low-value interventions such as pharmacological treatments and emergency visits.

To investigate the frequency of referrals and characterize people with LBP accessing primary care physical therapists, as well as characterize clinical and sociodemographic aspects and the use of health resources in Brazil.

Observational study using nationwide data on 1,459,710 adults with LBP, stratified according to G1: medical care only, G2: medical care and referral to physical therapist, G3: physical therapist as first contact. Data were analyzed descriptively.

1,405,145 people with LBP were included in G1, followed by G2 (N:14,079), and G3 (N:40,486). The majority was female (56.3 %), and the average age was 49 (±17) years for females and 48 (±17) for males. Less than 1 % (G2) were referred to physical therapists. Of these, 8085 (57.4 %) had an average duration of 17.4 days (±65.6) between referral and their clinical appointment, and 5994 (42.6 %) had a longer duration (261.1 ± 146.9 days). A total of 130,570 (8.9 %) participants were referred for imaging, totaling 152,150 exams. G1 had 105.65 exams/1000 people and 128 referrals to specialists/1000 people. G2 had 196.32 exams and 384.76 referrals to specialists/1000 people, and G3 had 22.87 exams and 64.89 referrals to specialists/1000 people.

We found a relatively low number of referrals of people with LBP to physical therapists in primary health care in Brazil, and a long period between the referral and the first contact with this professional. In addition, diagnostic imaging and referral to a specialist were frequently used.