Patients who received physical therapy early after an episode of acute low back pain had a lower risk of subsequent medical service usage than patients who received physical therapy at later times, say authors of an article published April 20 in Spine. Medical specialty variations exist regarding early use of physical therapy, with potential underutilization among generalist specialties, they add.
For this retrospective cohort study, the authors analyzed a national sample of the Centers for Medicare and Medicaid Services' physician outpatient billing claims. Patients were selected who received treatment for low back pain between 2003 and 2004 (n = 439,195). To eliminate chronic low back conditions, patients were excluded if they had a prior visit for back pain, lumbosacral injection, or lumbar surgery within the previous year. Main outcome measures were rates of lumbar surgery, lumbosacral injections, and frequent physician office visits for low back pain during the following year.
Based on logistic regression analysis, the adjusted odds ratio for undergoing surgery in the group of enrollees that received physical therapy in the acute phase (<4 weeks) compared with those receiving physical therapy in the chronic phase (>3 months) was 0.38, adjusting for age, sex, diagnosis, treating physician specialty, and comorbidity. The adjusted odds ratio for receiving a lumbosacral injection in the group receiving physical therapy in the acute phase was 0.46, and the adjusted odds ratio for frequent physician office usage in the group receiving physical therapy in the acute phase was 0.47.