In a retrospective cohort obtained
from electronic medical records and insurance claims data, initial physical
therapy management following a new primary care low back pain (LBP)
consultation was not associated with increased health care costs or utilization
of specific services. The authors of this article, which appears
online in Archives of Physical Medicine
and Rehabilitation, write that additional research is needed to examine the
cost consequences of initial management decisions made following a new
consultation for LBP.
Records and data were examined on 2,184 patients aged 18 and older with a
new consultation for LBP from 2004-2008 in single health care delivery system
in the United States. Patients were categorized as receiving initial physical
therapy management if care occurred within 14 days after consultation.
Total health care costs for all LBP-related care received in the year
following consultation were calculated from claims data. Predictors of
utilization of emergency care, advanced imaging, epidural injections,
specialist visits, and surgery were identified using multivariate logistic
regression. Generalized linear model was used to compare LBP-related costs
based on physical therapy utilization and identify other cost determinants.
Initial physical therapy was received by 286 of 2,184 patients (13.1%) and
was not a determinant of LBP-related health care costs or utilization of
specific services in the year following consultation. Older age, mental health
or neck pain comorbidity and initial management with opioids were determinants
of cost and several utilization outcomes.
member Julie M. Fritz, PT, PhD, ATC,
is the article's lead author. APTA members Gerard
P. Brennan, PT, PhD, Stephen J.
Hunter, PT, DPT, OCS, and John S.
Magel, PT, DSc, OCS, FAAOMPT, are coauthors.