Early Physical Therapy Reduces Back Pain Costs

by U.S. Medicine

June 8, 2015

SAN ANTONIO — Following an initial episode of acute, nonspecific low-back pain (LBP), early and guideline-adherent physical therapy resulted in substantially lower costs and reduced use of healthcare resources over a two-year period, according to a study conducted within the Military Health System.

The report was published recently in the journal BMC Health Services Research.1

The study, led by researchers from the Army-Baylor University Doctoral Program in Physical Therapy at Fort Sam Houston, analyzed 122,723 patients who went to a primary care physician following an initial LBP episode and received physical therapy within 90 days from Jan. 1, 2007 to Dec. 31, 2009.

Of these, 24% (17,175) received physical therapy within 14 days that adhered to guidelines for active treatment. During a two-year period, the patients made significantly less use of advanced imaging, lumbar spinal injections, lumbar spine surgery and opioids than did patients in other combinations of timing and adherence.

Early physical therapy patients also had 60% lower LBP-related costs as compared to 33.5% (23,993) of patients who had delayed and adherent physical therapy, defined as between 14 and 90 days.

“Physical therapy as the starting point of care in your low-back pain episode can have significant positive implications,” lead author John D Childs, PT, PhD, MBA, explained. “Receiving physical therapy treatment that adheres to practice guidelines even furthers that benefit.”

In military and other settings, clinical guidelines recommend avoiding opioids and advanced imaging procedures as a first line of treatment. Past research mainly performed in civilian settings, however, reveal that actual practice is inconsistent with those recommendations, according to background information in the recent study.

Childs suggests the study’s results also apply well to civilian settings by demonstrating an association between early-guideline-adherent care, costs and use of healthcare resources in a single-payer health system.

The authors call for future research to examine which patients with LBP benefit early physical therapy and determine strategies for providing early-guideline-adherent care.

1 Childs JD, Fritz JM, Wu SS, Flynn TW, Wainner RS, Robertson EK, Kim FS, George SZ. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Serv Res. 2015 Apr 9;15:150. doi: 10.1186/s12913-015-0830-3. PubMed PMID: 25880898; PubMed Central PMCID: PMC4393575.

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