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  • Early Guideline-Based Physical Therapy Results in Health Care Savings for Patients With LBP

    For patients with a first episode of low back pain (LBP), getting to physical therapy early—and receiving evidence-based interventions—are the keys to significantly reduced health care costs compared with delaying physical therapy or receiving "non-adherent" physical therapy treatments, according to a new study that analyzed health records of members of the US military.

    Researchers tracked health care costs over time by reviewing Military Health System records of 122,723 patients who were referred to physical therapy within 90 days of an initial visit to a primary care provider for a first episode of LBP. The study analyzed use of advanced imaging, spinal injections, surgery, opioid medication use, prescription use, and inpatient costs over a 2-year period, and linked these costs to how soon patients received physical therapy and what kind of physical therapy they received.

    To do this, researchers divided patients into 4 groups: those who received physical therapy within 14 days of the physician visit; those who received physical therapy after a wait of at least 14 days; those who received "adherent" physical therapy; and those who received "non-adherent" physical therapy. For purposes of the study, "adherent" physical therapy was defined as activities linked to CPT codes that reflected evidence-based recommendations for active physical therapy. Whenever more than 75% of the codes used in an episode of care were associated with active treatment (for example, therapeutic exercise or neuromuscular reeducation), and at least 1 active treatment code was used during each session, the episode was labeled "adherent."

    Researchers looked at the timing and adherence parameters individually and in combination, and found that the patients who received early and adherent physical therapy had a decreased likelihood of experiencing injections, surgery, advanced imaging, or opioid use compared with patients who received later, but still adherent, physical therapy. That decrease in utilization translated to health care costs that were on average 60% lower for the early adherent group.

    "When considering the various combinations, a dose-response relationship appears to exist in the sense that the results show a progressive increase in subsequent utilization and costs as care shifts from being classified as early and adherent compared to late and non-adherent care," authors write. An advance version of the article appears in the online edition of the journal BMC Health Services Research (.pdf).

    In an APTA news release, lead author John D. Childs, PT, PhD, emphasized what the study described as the "accretive" effects of timing and evidence-based practice.

    "Physical therapy as the starting point of care in your low back pain episode can have significant impact," he said. "Receiving physical therapy treatment that adheres to practice guidelines even furthers that benefit."

    The study arrives during a time when the value and efficacy of physical therapy for back pain have been getting noticed. Recent journal articles on physical therapy vs imaging for LBP, and physical therapy vs surgery for lumbar spinal stenosis have received attention in the general media as well as health care-focused publications.

    APTA President Paul Rockar Jr, PT, DPT, MS, believes that the BMC article adds another important dimension to the conversation about physical therapy's ability to transform health care—namely, the ways in which receiving physical therapy early on can reduce health care costs.

    "Given the enormous burden of excessive and unnecessary treatment for patients with low back pain, cost savings from physical therapy at the beginning of care has important implications for single-payer health care systems," Rockar said.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Comments

    • One major flaw in the interpretation of the study is that most first time episodes of LBP typically resolve spontaneously within the first month so no wonder these patients will not need further interventions including Imaging, injections, medication etc. and thus the cost of care is less.

      Posted by Dr. Alon on 4/15/2015 4:42 PM

    • Dr. Alon: Understand the point but if you look at those first timers seeing an MD first the injections, MRIs, labs and medication are notoriously utilized. Seeing the PT first allows for the education and body mechanics to be taught as they spontaneously improve. The teaching of movement is a necessity for most of us. The fact is that seeing a PT first drastically reduces the cost of the episode. This has been proven as early as the early'80s and continues to be proven in recent studies. Where Primary Care Practitioner Status for PT is allow and utilized the health care costs are reduced significantly for Neuro-musculoskeletal patients.

      Posted by Jerry L. Klug, PT, DPT on 4/30/2015 6:25 AM

    • Coming from someone who suffers with chronic back pain, I wish I would have consulted with a physical therapist earlier. If I had, I think my treatment progression would have been significantly more progressed than it is currently. Although seeing licensed doctors can help, sometimes you really just need to see a licensed physical therapist—it's their specialty. Alex Jennings |

      Posted by Alex Jennings on 5/27/2015 1:09 PM

    • Most first time episodes of LBP resolve spontaneously, but can have a 75% recurrence rate in 2-3 years. This compared to 35% for those after PT with a preventative exercise program. Julie A. Hides, PhD, MPhtySt, BPhty,*† Gwendolen A. Jull, MPhty, FACP* and Carolyn A. Richardson, PhD, BPhty(Hons)*Long-Term Effects of Specific Stabilizing Exercises for First-Episode Low Back Pain. SPINE Volume 26, Number 11, pp E243–E248 ©2001, Lippincott Williams & Wilkins, Inc.

      Posted by J. Grace, PT, DPT, OCS on 5/29/2015 3:08 PM

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