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  • Is Physical Therapy Cost-Effective? It's Complicated

    A new systematic review takes on the question "is physical therapy cost-effective?" and responds with a definitive "it depends." But the equivocation isn't about whether physical therapy treatment actually makes a difference in patients as it is about the definition of "cost-effective"—and particularly, whether that definition includes societal costs.

    According to authors of the review, e-published ahead of print in the December issue of Physical Therapy (PTJ), APTA's research journal, there is little doubt that physical therapy improved health in nearly all 18 studies reviewed. But the question of whether the therapy was cost-effective is a little harder to pin down, with authors of this study applying a fairly rigorous definition of "cost-effectiveness" and finding that about half the studies cleared the bar.

    Researchers analyzed studies between 1998 and 2014 that compared physical therapy with usual care only, as well as studies that compared physical therapy added to usual care with usual care only. Of the 18 studies, 13 were classified as focusing on musculoskeletal issues, 2 were linked to "internal conditions" (urinary incontinence and intermittent claudication), 2 were related to neurological conditions, and 2 to what authors called "internal medicine" (falls prevention and the intermittent claudication study, which was also included in the internal conditions category). Studies reviewed were limited to only those that included data that would allow for an analysis of cost-effectiveness.

    Authors of the study found that in the 8 physical therapy vs usual care settings, the physical therapy approach was cost-effective in 5 studies—4 of those related to musculoskeletal conditions. Among the 11 studies that compared physical therapy plus usual care with usual care only, the addition of physical therapy was cost-effective in 4 of 11 studies.

    Authors of the study arrived at a cost-effectiveness determination by analyzing the cost difference between the intervention and the usual care divided by the difference in health outcome provided by the 2 treatments. Authors explain that this could at times be a difficult thing to nail down, as several studies didn't analyze data this way, and the manner in which outcomes are measured can vary.

    In the end, authors employed what they describe as a "very strict" definition of cost-effectiveness.

    "To be cost-effective, an intervention has to be cheaper than the standard treatment," authors write. "Usually, a more expensive intervention is accepted if additional costs are not too high. However, there is no clear defined cutoff above which costs should be considered as too high, hence our choice."

    That strict definition helped with the analysis, but doesn't necessarily capture the idea that physical therapy can be even more cost-effective when societal costs and long-term outcomes are factored in, according to the analysis.

    "Physical therapy sessions added to usual care increases health care costs," authors write. "However, when the analysis includes societal costs, such as costs related to absence from work, then the total costs are not higher for the group who received physical therapy added to usual care …. Therefore, cost-effectiveness analyses should not be limited to health care costs; total costs which consider both aspects are more relevant." Authors also noted that the strongest links to the cost-effectiveness of physical therapy—musculoskeletal conditions—are in an area of health care that affects large populations and generates considerable costs over time.


    • Thanks for the summary of this very interesting study! I wonder what the "usual care" involved exactly? Does this relate to the care accorded by general practitioners (doctors)? Does it include surgical intervention when this is indicated? (I am assuming not). I think the conclusion really hits the spot though. There is a net economic benefit to society at large if people can recover speedily, as they can invest and generate greater economic benefit to society in good health. I think there is therefore a strong argument for physical therapy and related "allied" professions such as osteopaths, exercise physiologists, advanced remedial massage therapists, etc to be included in health care financial models. After all, "usual care" is not a big cost to the consumer, so to compare like for like, physical therapy needs to be following the same financial subsidy model as "usual care"!

      Posted by Massage Neutral Bay on 12/23/2015 12:36 AM

    • Did they look at costs in private clinics vs hospital based clinics. The cost difference can be staggering.

      Posted by Dan Fleiry on 12/23/2015 12:18 PM

    • Dan, my thoughts exactly. HUGE disparity in private practice vs hospital or even POPTS-based clinics.

      Posted by Ron Pavkovich on 12/26/2015 7:19 AM

    • I also wonder how "usual" medical care is defined in this study with regard to the use of pharmaceuticals, pain/management, diagnostics and/or surgical intervention? More patients are experiencing direct access to physical therapy, and also earlier physical therapy intervention upon referral by their treating physicians. Eg. many health insurance carriers are requiring several sessions of P.T. prior to authorizing an MRI or specialized (and expensive) diagnostic tests. And now with the CDC's position statement regarding prescription opiates and the heroin epidemic, there is increasing medical and public awareness of the need to include non-pharmaceutical options to enhance quality of life and function. I am looking forward to reading this study to see how the authors define and evaluate "cost effectiveness," "societal costs" and "long-term outcomes" for the heath of our patients. Darcy Higgins, PT

      Posted by Darcy Higgins -> @MX on 12/27/2015 12:10 PM

    • These are good attempts at a very broad need. Again I have supported the use of the SF 36/12/8 instruments for 25 years but have never been able to get physical therapy institutions interested. Mental health benefits of physical therapy are very important but as usual not included in in many studies.

      Posted by Max Morton PhD, LPT, ATC on 12/27/2015 7:50 PM

    • The reimbursement for a private PT has won the race to the bottom. It has put us the realm of usual care such as massage, pilates & trainers. Now you can pay for the education to become a DPT and make no money and be in debt for several years. The problem is most people want to make more money with the amount of education we have. This is where the educators win. More years of school equals more money for the college & professors. The reimbursement is too low. The insurance executives make millions per person. While physical therapist struggle to survive. Compare our cost to the enormous salaries of insurance executive and physical therapy becomes very cost effective. If your in private practice your on your own. The APTA will not help in this battle. The APTA is for students, educators and continuing education. The APTA has not developed any viable economic plan to help private practice or the wages of physical therapists increase.

      Posted by David Dennies on 12/28/2015 6:04 PM

    • The definition of " cost effective " is horrible. This is a great example of NOT understanding practice realities. Success or failure of PT is the current default for insurance companies allowing more expensive procedures, including MRI, a variety of expensive injections, implantable devices and surgery. Currently, PT in a Physicians office, is being used to justify more expensive procedures. After 5 or 6 visits, " conservative care " is declared a failure and more expensive procedures are allowed; procedures that are performed by staff in the Physician's office. Limited treatment is encouraged by CMS through their statistical " help ", exposing " statistically excessive " treatment by PT's. With each statistical reminder, the number of PT visits and the time spent with patient care decreases. Often, we are not allowed to determine if PT would have been effective at all, much less cost effective. Where is that study? This study feeds into insurance companies wheel house by examining a phenomenon in such narrow parameters that the results don't represent real life. When do we stop pursuing studies like this? Just because a specific question can be answered, doesn't make the study valuable.

      Posted by Brian P. D'Orazio on 1/10/2016 9:10 PM

    • I've been thinking of going to physical therapy. I used to play a lot of sports and have a lot of old injuries. They cause pain from time to time so having someone help me through the pain instead of taking pills would be awesome.

      Posted by alena on 9/26/2017 8:36 PM

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