Friday, July 22, 2016 Study: Early Physical Therapy for Neck Pain Makes Sense for Patients, PTs, and Payers According to a new study, providing physical therapy within 4 weeks after an individual first experiences neck pain is a win-win-win proposition for physical therapists (PTs), payers, and most importantly, patients. Researchers found that getting to a PT early not only achieved more improvement per $100 spent, but actually doubled a patient's odds of decreased disability compared with patients who were treated after a delay of more than 4 weeks. Researchers tracked 1,531 patients using an outcomes management system maintained by Intermountain Healthcare, a private nonprofit system, to analyze changes to disability and pain scores through an episode of neck pain. Patients were included if they had 2 more visits to a PT over fewer than 180 days, and if they recorded scores of 10 or greater on the Neck Disability Index (NDI) and 2 or greater on the Numerical Pain Rating Scale (NPRS). Patient records were then divided into 2 groups: 1 group of 451 patients who reported experiencing symptoms for fewer than 4 weeks, and a second group of 1,080 patients who reported symptoms that were present for 4 weeks or longer. Here's what researchers found: For the early therapy groups, the odds of achieving a minimal clinically important difference (MCID) in disability doubled for the early-therapy group—and increased by nearly as much for pain. Researchers found, on average, that patients were twice as likely to achieve at least a 19 percentage point change in the NDI, and were 1.82 times more likely to record a drop of at least 1.3 points on the 10-point NPRS. The greater decreases in disability and pain translated into more bang for the health care buck. Early-therapy patients averaged a 2.27 percentage point improvement in disability scores per $100 spent, compared with later-therapy patients, whose disability scores dropped by 1.22 percentage points per $100. PTs and patients were able to achieve more improvement per-session when physical therapy started earlier—what authors describe as "more efficient care." On average, early-therapy patients saw disability scores drop by 3.44 percentage points per visit, compared with a 1.81 percentage point drop for the later-therapy group. Pain scores followed a similar pattern, with pain dropping by .57 points for the early-therapy patients, compared with a .42 percent drop for the later-therapy group. Authors of the study, published in BMC Health Services Research, write that the findings support the "value proposition" for early physical therapy, with benefits reaching payers, PTs, and patients: payers realize lower costs, PTs can make a bigger difference, and patients experience changes that not only improve their lives, but lower their indirect costs through decreases in work absenteeism and disability. Researchers conclude that, similar to earlier research supporting early physical therapy for treatment of low back pain, their study contributes to the conversation around health care's shift away from fee-for-service models, and toward value-based care. "Policymakers and payers contribute to the value equation by designing health policies that promote access and use of timely, appropriate, health care services," authors write. "The implication of these findings suggests that a health care system that provides pathways for patients to receive early [PT] management of neck pain may realize improved patient outcomes, increased efficiency in delivery of care, and greater value." Authors of the study include Maggie Horn, PT, DPT, MPH, PhD, Gerard Brennan, PT, PhD, Steven George, PT, PhD, Mark Bishop, PT, PhD, and Jeffrey Harman, PhD. 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.