Implications of early and guideline adherent physical therapy for low back pain on utilization and costs

Abstract

BackgroundInitial management decisions following a new episode of low back pain (LBP) are thought to have profound implications for health care utilization and costs. The purpose of this study was to evaluate the impact of early and guideline adherent physical therapy for low back pain on utilization and costs within the Military Health System (MHS).MethodsPatients presenting to a primary care setting with a new complaint of LBP from January 1, 2007 to December 31, 2009 were identified from the MHS Management Analysis and Reporting Tool. Descriptive statistics, utilization, and costs were examined on the basis of timing of referral to physical therapy and adherence to practice guidelines over a 2-year period. Utilization outcomes (advanced imaging, lumbar injections or surgery, and opioid use) were compared using adjusted odds ratios with 99% confidence intervals. Total LBP-related health care costs over the 2-year follow-up were compared using linear regression models.Results753,450 eligible patients with a primary care visit for LBP between 18–60 years of age were considered. Physical therapy was utilized by 16.3% (n = 122,723) of patients, with 24.0% (n = 17,175) of those receiving early physical therapy that was adherent to recommendations for active treatment. Early referral to guideline adherent physical therapy was associated with significantly lower utilization for all outcomes and 60% lower total LBP-related costs.ConclusionsThe potential for cost savings in the MHS from early guideline adherent physical therapy may be substantial. These results also extend the findings from similar studies in civilian settings by demonstrating an association between early guideline adherent care and utilization and costs in a single payer health system. Future research is necessary to examine which patients with LBP benefit early physical therapy and determine strategies for providing early guideline adherent care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0830-3) contains supplementary material, which is available to authorized users.

Relationship of Opioid Prescriptions to Physical Therapy Referral and Participation for Medicaid Patients with New-Onset Low Back Pain

“…7,8,25 Results from the current study were mixed. With a smaller sample, few participants received spinal injections and only 3 (0.7%) had surgery limiting our ability to detect differences between these groups.…”

“…7,8,17 In this cohort of Medicaid recipients in a single health system, we examined an intermediate step between a primary care provider visit and PT participation, a PT consult. Both patient characteristics and procedural decisions (prescriptions and imaging) were associated with patients receiving a PT consult and subsequently participating in PT.…”

“…5,6 In particular, PT early in the management of LBP is associated with reductions in subsequent health care utilization and LBPrelated costs. [7][8][9] Studies supporting PT early in the management of LBP have not examined the frequency with which PT was recommended, only the frequency with which it was received. The proportion of patients receiving early PT is low, between 7% and 20% 7,8,10 , but the proportion of patients referred is not known.…”

“…[7][8][9] Studies supporting PT early in the management of LBP have not examined the frequency with which PT was recommended, only the frequency with which it was received. The proportion of patients receiving early PT is low, between 7% and 20% 7,8,10 , but the proportion of patients referred is not known. Identifying only patients who have participated in PT fails to account for the impact of the referral itself.…”

Description of Common Clinical Presentations and Associated Short-Term Physical Therapy Clinical Outcomes in Patients With Neck Pain

“…The finding of improved outcomes with early care has been supported not only in the neck pain literature 28,43 but also in the low back pain literature. 44 These convergent findings suggest consideration of practice or policy level changes in the future if more efficient management of spine pain is to be realized.…”