Clinical outcomes of early and later physical therapist services for older adults with back pain

Physical Therapy and Hospitalization Among Medicare Beneficiaries With Low Back Pain

“…5,7,8,15,16 For example, Gellhorn and colleagues 5 showed that among Medicare beneficiaries with low back pain, early receipt of PT was associated with reduced downstream healthcare costs including greater than 50% reduced odds of surgery, lumbosacral injections and primary care visits in the next year. In addition, recent research reported similar functional outcomes among patients with lumbar spinal stenosis who were randomized to PT or surgical decompression, although a large number of patients randomized to PT eventually crossed over to have surgery.…”

“…This is similar to Fritz et al, 7 who reported that among Medicare beneficiaries with a lumbar spine condition, a greater number of visits were associated with better clinical outcomes. Recently, Rundell et al, 8 reported that among patients age 65 from the Back pain Outcomes using Longitudinal Data (BOLD) registry, a larger dose of PT (10+ CPT codes versus 3-9 or 1-2 codes) was associated with better functional outcomes at 12-months. In contrast, Resnik and colleagues 17 found that among a sample of 114 outpatient PT clinics, the best performing clinics for patients with low back pain had significantly fewer visits compared to the worst performing clinics (7.7 vs. 9.3), although their sample was much younger (average age 49) and less similar to the current study.…”

Using Pain Medication Intensity to Stratify Back Pain Among Older Adults

“…Opioids are reserved for higher pain intensities not manageable with lower-level pain medications; about 40% to 45% of older adults with back pain receive opioids [7,23]. Physical therapy can be integrated into back pain treatments, but no standardized prescriptions for physical therapy type (e.g., active, passive), timing (e.g., early within one to 28 days, later after three months), or dose levels (e.g., one to four sessions, five to nine sessions, ≥10 sessions) have been determined [2,20,24]. About 35% of back pain patients receive some type of physical therapy, with a median of four sessions [24].…”

“…About 35% of back pain patients receive some type of physical therapy, with a median of four sessions [24]. Utilization patterns for physical therapy indicate that, while high-dose (≥10 sessions) and early (within one to 28 days) physical therapy may be most effective, only about 17% receive high doses and about 13% receive early physical therapy [20,24]. There has been concern that physical therapy may needlessly increase health care spending without apparent benefits, especially for younger adults, but a relationship between physical therapy and subsequent health care procedures or increased expenditures has not been substantiated [23,25].…”

“…Insomnia and other sleep problems associated with back pain further compromise quality of life among older adults [1,29,30]. Although active, high-dose, and early physical therapy has been associated with increased function and decreased pain intensity and/or duration, the delivery and effectiveness of physical therapy is not consistent [20,24]. A key benefit of physical therapy may be to preserve long-term function and prevent disability for older adults, even if pain intensity or duration may not be consistently impacted [24].…”