A new study published in Spine shows that
early treatment by a physical therapist for low back pain (LBP), as compared to
delayed treatment, was associated with reduced risk of subsequent healthcare
utilization and lower overall healthcare costs.
Using a national database of
employer-sponsored health
plans, researchers examined a sample of 32,070 patients who were newly
consulting a primary care physician for low back pain. Patients
were identified and categorized based on their use of physical therapist
services within 90 days of the consultation.
Those
who were referred to a physical therapist early (within 14 days of the
consultation) showed a reduced risk of subsequent healthcare utilization and
experienced lower overall healthcare costs than did those patients with delayed
treatment by a physical therapist (within 15-90 days of consultation).
During
an 18-month follow-up period, researchers found that early treatment by a
physical therapist was associated with reduced risk of subsequent surgery,
injections, physician visits, opioid use, and advanced imaging,
along with a corresponding reduction in overall LBP-related medical costs relative
to delayed treatment by a physical therapist.
Total healthcare costs for
patients receiving early care from a physical therapist were an average of
$2,736.23 lower.
According
to the study's lead author, Julie M. Fritz, PT, PhD, ATC, associate professor
in the Department of Physical Therapy at the University of Utah and clinical
outcomes research scientist at Intermountain Healthcare in Salt Lake City,
"The value of referring patients to physical therapy who are newly
consulting primary
care physicians for low back pain likely depends on the timing of the
referral and how patients adhere to physical therapy guidelines that recommend
maintaining and improving activity levels."
She
added, "Despite the fact that primary care practice guidelines generally
recommend delaying referral to a physical therapist for several weeks, we found
that about half the patients receiving treatment from a physical therapist did
so within two weeks, which is a practice that may be justified by emerging
evidence."
Fritz
explained that one possible reason for the link between early care by a
physical therapist and positive outcomes may be that physical therapists can
contribute to promoting a greater sense of self-reliance in managing LBP and
confidence in a positive outcome. "If a physical therapist's treatment
assists in developing self-efficacy, it is reasonable to expect it would have
greater impact when implemented very early, before negative expectations have
become reinforced and entrenched." Fritz added that early care
administered by a physical therapist may offer an alternative to management
strategies that can foster a sense of dependency in the patient, such as use of
MRI or opioids.
The
study found that patients using a PPO plan were more likely to receive early
treatment from a physical therapist (53.4%) as compared with those using an HMO
plan (44.7%). Also, the highest rates of physical therapist utilization were
found in the Northeast and West. Patients in the Midwest were more likely to
seek early treatment from a physical therapist (58.7%).
An
April 20 study in Spine also supports the benefits of early
physical therapy for low back pain. In this study, researchers found that patients
who received physical therapy early (within 30 days) after an episode of acute
low back pain had a lower risk of subsequent medical service usage (surgery or
epidural steroid injections) than patients who received physical therapy later.
In this study, authors analyzed a national sample of the Centers for Medicare
and Medicaid Services' physician outpatient billing claims.
Currently
47 states and the District of Columbia allow some form of direct access to
physical therapists for treatment/intervention, although some states impose
restrictions if patients have not been referred by a physician.
Provided
by American
Physical Therapy Association
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