The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to neck pain. J Orthop Sports Phys Ther. 2017;47(7):A1–A83. doi:10.2519/jospt.2017.0302

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.

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Remarkably little is known about what constitutes a good residency or fellowship training program. In contrast to entry-level programs, the job of residency and fellowship educators is sometimes more subtle and difficult to articulate. Developing advanced clinical reasoning, communication skills, use of evidence, and patient-management approaches beyond entry-level competencies for students of various levels of education and backgrounds creates unique and diverse teaching challenges. There is no gold standard and precious little evidence to guide us on how best to sequence and pace residency/fellowship curricula, integrate mentoring into didactic and clinical coursework, conduct examinations, and measure the impact of training on patient care. To this end, we'd like to congratulate Drs Rodeghero, Wang, Flynn, Cleland, Wainner, and Whitman on their paper, “The Impact of Physical Therapy Residency or Fellowship Education on Clinical Outcomes for Patients With Musculoskeletal Conditions.” This is a significant first step in the effort to explore that most important challenge of any health profession's educational initiatives: did training result in improved patient outcomes?

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