Initial presentation for acute low back pain: is early physical therapy associated with healthcare utilization and spending? A retrospective review of a National Database

Abstract

Background Early initiation of physical therapy (PT) has been associated with lower healthcare costs and utilization; however, these studies have been limited to single institutions or healthcare systems. Our goal was to assess healthcare utilization and spending among patients who present for the first time with low back pain (LBP), according to whether they received early physical therapy (PT), using a large, nationwide sample; and geographic variation in rates of early PT and 30-day LBP-related spending. Methods Using the Truven MarketScan database, we identified nearly 980,000 US adults ages 18–64 years who initially presented with acute LBP from 2010 through 2014 and did not have nonmusculoskeletal causes of LBP. Approximately 110,000 patients (11%) received early PT (≤2 weeks after presentation). We compared healthcare utilization and spending at 30 days and 1 year after presentation between patients who received early PT and those who did not. Alpha = 0.05. Results At 30 days, early PT was associated with lower odds of chiropractor visits (odds ratio [OR] = 0.41, 95% confidence interval [CI] = 0.40–0.42), pain specialist visits (OR = 0.49, 95% CI = 0.47–0.51), emergency department visits (OR = 0.51, 95% CI = 0.49–0.54), advanced imaging (OR = 0.57, 95% CI = 0.56–0.58), orthopaedist visits (OR = 0.67, 95% CI = 0.66–0.69), and epidural steroid injections (OR = 0.68, 95% CI = 0.65–0.70). At 1 year, early PT was associated with less healthcare utilization. At 30 days, patients with early PT had lower mean LBP-related spending ($1180 ± $1500) compared with those without early PT ($1250 ± $2560) (P < 0.001). At 1 year, LBP-related spending was significantly less among patients who did not receive early PT ($2510 ± $3826) versus those who did ($2588 ± $3704). Early PT rates (range, 4–25%; P < 0.001) and 30-day LBP-related spending differed by state (range, $421 to −$410; P < 0.001). Conclusion Early PT for acute LBP was associated with less 30-day and 1-year healthcare utilization and less 30-day LBP-related spending. Early PT rates and 30-day spending differed by US state. Level of evidence IV

Characteristics of Chiropractic Patients in the Veterans Health Administration During the COVID-19 Pandemic: A Cross-Sectional Analysis

“…The VHA CDW system likely contains discrepancies common to large data warehouses, such as miscoding, mislabeling, and discrepancies in updating data. 48 , 49 , 50 Despite this, previous work has shown much reason to be confident in the accuracy of VHA CDW data. 51 , 52 The “TCC only” group of patients contained primarily telephone visits that did not represent the full breadth of chiropractic telehealth.…”

Clinician approaches to new spine pain cases in primary care: Balance of opioid prescribing and early linkage to exercise therapy and spinal manipulation

“…12 Also, a recent evaluation of almost one million outpatient visits for acute LBP found that the minority (11%) of patients referred to prompt (less than 15 days after presentation) PT incurred significantly lower health care costs. 13 Similarly, a large study of early PT for acute LBP found significant reductions in subsequent use of lumbosacral injections, lumbar surgery, and frequent physician office visits for LBP. 14 A clinic created in the US military to promptly evaluate acute LBP (with opportunity for medication receipt) by PTs found improved outcomes, including less medication and imaging.…”

“…A study of US Army soldiers found early treatments for LBP improved military readiness outcomes 12 . Also, a recent evaluation of almost one million outpatient visits for acute LBP found that the minority (11%) of patients referred to prompt (less than 15 days after presentation) PT incurred significantly lower health care costs 13 . Similarly, a large study of early PT for acute LBP found significant reductions in subsequent use of lumbosacral injections, lumbar surgery, and frequent physician office visits for LBP 14 .…”

Use of implementation mapping in the planning of a hybrid type 1 pragmatic clinical trial: the BeatPain Utah study

“…Among persons with LBP, rates of opioid prescribing are about double rates of nonpharmacologic care. [8][9][10][11][12][13][14] Considerable disparities exist in chronic pain prevalence and management. Prevalence is higher among persons with less income or education, and in rural communities.…”