For some patients, physical therapy can both decrease overall health care utilization and save money down the road—especially if delivered sooner rather than later. These were the takeaways from 2 articles in a May 2018 special issue on nonpharmacological management of pain published by PTJ (Physical Therapy), APTA's scientific journal. PTJ Editor-in-Chief Alan Jette, PT, PhD, FAPTA, interviewed authors of each of the studies via podcast.
One study, coauthored by Xinliang “Albert” Liu, PhD, examined the effect of timing of physical therapy on downstream health care use and costs for patients with acute low back pain (LBP) in New York state. The patients were categorized by whether and how soon they received physical therapy after seeing a physician for LBP: at 3 days, 4–14 days, 15–28 days, 29–90 days, and no physical therapy. Patients who received physical therapy within 3 days (30%) incurred the lowest costs and utilization rates, while those who didn’t see a PT at all saw the greatest of both.
In the PTJ podcast, Liu observed that among those who did not receive physical therapy there was “greater variety in health care utilization and costs," pointing out that factors influencing costs include age, living in nonmetropolitan areas, type of insurance coverage, comorbidities, and whether they were prescribed opioids or other medications. He cautioned that “we don’t have the evidence” yet to say that all patients with LBP should be referred immediately to physical therapists, but he hopes that future research can “identify subgroups that would potentially benefit from physical therapy and lower their health care utilization and costs.”
A separate study explored downstream health care utilization and costs for Veterans Affairs patients who received physical therapy, opioids, or both after hip surgery. After 2 years, patients who received only physical therapy had lower overall health care costs than those who only received opioids and had fewer return visits for surgical fixes or replacements. Among the 56% of patients who received both, those who received physical therapy first had lower costs, had fewer opioid prescriptions, and were less likely to use opioids long-term.
Coauthor Daniel Rhon, PT, DPT, DSc, told Jette, “Perhaps when you see a physical therapist first, there is more appropriate pain education and pain management…and that sends the patient down this pathway that results in better outcomes. I think there’s a prevailing thought…that you need to be pain-free before you get to physical therapy, and that it’s going to be really painful, and some physicians and some patients might wait” to refer a patient to physical therapy.