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  • Study: Early Physical Therapy for Neck Pain Associated With Lower Imaging Rates, Opioid Prescriptions, and Overall Cost

    In findings on neck pain that echo the results of similar studies on low back pain, researchers have identified an association between early consultation with a physical therapist (PT) and lower rates of opioid prescription, imaging, and injections. Those lower-use rates contributed to significant cost savings over a 1-year study period compared with patients who waited 90 days or more before seeing a PT, according to the study's authors.

    The study, published in BMC Health Services Research, looked at health care utilization over 1 year among 308 patients who presented with neck pain. The patients were divided into 3 groups: an "early" group that consulted a PT within 14 days, a "delayed" group that received a PT consultation between 15 and 90 days after initial health care provider consultation, and a "late" group that waited from between 91 and 364 days to consult with a PT. All patients were members of the University of Utah Health Plans, either through private insurance or via Medicaid, and none had a recorded health care encounter for neck pain in the 90 days preceding initial consultation. APTA members Maggie Horn, PT, DPT, PhD; and Julie Fritz, PT, PhD, FAPTA, coauthored the study.

    Horn and Fritz tracked rates of spinal injection, opioid prescription, imaging (MRIs, X-rays, and CT scans), and overall health care costs at the 1-year mark, analyzing data for each group. Demographic and comorbidity information also was collected and compared.

    Overall, of the 3,533 patients who reported a new neck pain encounter with a health care provider, only 15.1% had a consultation with a PT over the entire 1-year study period. Of the 536 patients who consulted with a PT, 308 were deemed eligible for the study. The average age of patients in the study was 48.7 years, and most (69.2%) participants were women.

    Among the findings:

    • Overall, 35% of patients in the study received spinal injections at some point; however, compared with the early group, the delayed group was 5.34 times more likely than the early group to receive an injection, while the late group was 4.36 times more likely to receive the treatment compared with the early group.
    • Opioids were prescribed to 62.7% of all patients. However, when broken down by early, delayed, and late groupings, the late group was estimated to be 2.79 times more likely to receive an opioid prescription than the early group. The delayed group had about the same odds of receiving a prescription as the early group.
    • When it came to imaging, the delayed and late groups were more than 4 times as likely to receive an MRI and nearly 3 times as likely to receive an x-ray compared with the early group. Rates of CT scans were small—only 7% of all patients—but the late group was more likely to receive the imaging. There were no significant differences between the early and delayed groups related to CT scan rates.
    • At the end of 1 year, the average adjusted total health care cost for the early group was $1,853—about $1,000 less than the cost for the delayed group ($2,917) and less than half the cost associated with the late group, which averaged $4,026.
    • The median episode-of-care (EOC) for all 3 groups was 155 days, with the early group reporting the shortest median EOC, at 49 days, compared with the late group median EOC of 319 days. The groups reported no significant differences in the median number of physical therapist visits (3) over a median 22 days.
    • Among the 3 groups there were no significant differences in the prevalence of depression, anxiety, fibromyalgia, or obesity. The late physical therapy group tended to have more participants with low back pain, chronic or generalized pain, substance abuse, and tobacco use.

    "Current trends in health care costs are becoming unsustainable for payers and patients and are not resulting in improved outcomes," authors write. "The findings from our study indicate that consulting a physical therapist early for neck pain, within 14 days of an index visit, may provide an opportunity to mitigate downstream health care utilization while containing costs."

    Authors note that the increased odds of diagnostic testing and invasive treatments they found in their neck pain study is similar to patterns other research has uncovered in the treatment of low back pain (LBP), albeit with increased comparative risk. They speculate that this could have something to do the available evidence on the treatment of neck pain as a discrete condition.

    "In our study, providers may be more likely to use diagnostic testing or more invasive treatments prior to initiating physical therapy, potentially due to the lack of preponderance of evidence for treating neck pain," authors write. "Conversely, early physical therapy consultation may shield patients from this utilization pattern."

    Authors acknowledge that their study is limited to a single group of insured patients, in a single geographic location, using a single health care system, and that results "cannot be interpreted as causal or widely generalizable." Still, they write, the association they uncovered bears further study.

    "Future studies need to further explore improving earlier access to physical therapy for patients with neck pain," authors write. "Specifically future studies need to determine the effect of early physical therapy consultation within the primary care setting or through direct access in a formal randomized controlled trial."

    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.

    PT in Motion Magazine Looks at PTs in Primary Care

    Think the idea of the physical therapist (PT) as a primary care provider is some kind of far-off, pie-in-the-sky concept? Don't tell that to Tony Bare, PT, DPT, ATC; or Rebecca Byerley, PT, DPT; or Kaiser Permanente of Northern California, for that matter. They're already doing it—and doing it successfully.

    This month in PT in Motion magazine: Associate Editor Eric Ries takes an in-depth look at PTs in the primary care space, where they assume roles that range from a "roving PT" member of a multidisciplinary primary care team (the Kaiser approach), to a clinician in private practice who is often a patient's first point of contact with the health care system. Bare and Byerley are examples of the latter, both of whom have thriving practices in very different settings.

    The article features various PTs' perspectives on what it takes to provide primary care and outlines what APTA is doing to promote the concept. Ries also covers the longstanding use of PTs as primary care providers in the military and interviews PTs for their perspectives on the barriers to adopting a similar model in the civilian world, as well as the broad cultural hurdles that will need to be overcome to make the primary care PT more common.

    "Deepening Physical Therapy's Footprint: PTs in Primary Care" is featured in the December-January Issue of PT in Motion magazine and is open to all viewers—pass it along to nonmember colleagues to show them one of the benefits of belonging to APTA. Also in the December-January issue: APTA’s Emerging Leaders and the Catherine Worthingham Fellows of the American Physical Therapy Association share their views on such professional issues as the role of research, networking, education, mentors, and the future of the profession. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.