Explanatory multivariate modeling for disability, pain, and claims in patients with spine pain via a physical therapy direct access model of care

Abstract

BACKGROUND: Direct access physical therapy (DAPT) may result in improved patient outcomes and reduced healthcare costs. Prognostic factors associated with spine-related outcomes and insurance claims with DAPT are needed. OBJECTIVE: To identify factors that predict variations in outcomes for spine pain and insurance claims using DAPT. METHODS: Individuals (N = 250) with spine pain were analyzed. Outcomes were classified into High, Low, or Did Not Meet minimal clinically important difference (MCID) scores. Claims were categorized into low, medium, or high tertiles. Prognostic variables were identified from patient information. RESULTS: Females were more likely to meet High MCID (odds ratio [OR] 2.84 (95% CI = 1.32, 6.11) and Low MCID (OR 2.86, 95% CI = 1.34, 6.10). Higher initial ODI/NDI scores were associated with High MCID (OR 1.04, 95% CI = 1.07, 1.22) and Low MCID (OR 0.91, 95% CI = 0.77, 1.07). Odds of a high claim were lowered by the absence of imaging (OR 0.04, 95% CI = 0.02, 0.09) and an active versus passive treatment (OR 0.38, 95% CI = 0.18, 0.80). CONCLUSION: Females and higher initial disability predicted favorable outcomes. The novel introduction of claims into the prognostic modeling supports that active interventions and avoiding imaging may reduce claims. Neck pain (NP) and low back pain (LBP) are two of 2 the most common musculoskeletal conditions, with a 3 global point prevalence of 4.9% [1] and 9.4% [2], re-4 * . spectively. In the United States (US), 15% of all indi-5 viduals report experiencing NP and 29% report LBP 6 within the previous three months [3]. Whereas a ma-7 jority of persons with NP and LBP may have favorable 8 outcomes with or without treatment, a notable percent-9 age of the population will go on to develop chronic or 10 recurring pain and disability. Over a third of individu-11 als who develop NP will develop persistent symptoms 12 that last longer than six months [4]. Similarly, 24% 13 File: bmr-1-bmr171074.tex; BOKCTP/ljl p. 2 2 C. Green et al. / Explanatory multivariate modeling for disability, pain, and claims in patients LBP will continue to have recurring episodes through-15 out their lifetime [5,6]. 16 Numerous studies have examined prognostic fac-17 tors related to NP and LBP and predicting disability 18 based on these factors. There is strong evidence that 19 older age, a longer duration of symptoms, a history of 20 neck problems, and co-existing musculoskeletal disor-21 ders are poor prognostic factors for non-specific NP [7] 22 and high baseline disability, heightened psychologi-23 cal stress, older age, radicular symptoms, litigation, 24 and physically demanding work are prognostic for 25 LBP [8]. Interestingly, prognostic factors across stud-26 ies seem largely dependent on how outcomes were de-27 fined within the studies [9,10]. There is substantial 28 variability amongst predictive models using different 29 MCIDs on the Oswestry Disability Index (ODI) in the 30 LBP population [10]. For NP, studies of prognostic fac-31 tors have lacked predictors for outcome from a...

Can Haglund’s Syndrome Be Misdiagnosed as Low Back Pain? Findings from a Case Report in Physical Therapy Direct Access

“…Moreover, DA to a PT seems to offer appropriate care for MSK pain-suffering patients [ 10 , 12 , 28 , 29 , 30 ], and has produced improved functional outcomes and better cost-effectiveness ratios [ 29 ]. Indeed, patients in DA received fewer imaging investigations and a higher percentage of active treatments than passive, resulting in a lower burden of time and economical costs [ 31 ]. It is noteworthy that our comparison of the GP-led care and the DA model of care has demonstrated a potential reduction of 32 days in favor of the latter (see Figure 5 ), resulting in a faster pathway, even when a proper medical referral is needed.…”