According to a report released by the Workers Compensation Research Institute, getting physical therapy for low back pain within 14 days of injury is associated with significant reductions in the use and costs of medical services such as MRIs, opioid prescriptions, pain management injections, and low back surgery. It also is linked to shortened duration of temporary disability benefits under worker's compensation. The institute is an independent nonprofit organization devoted to "providing the public with objective, credible, high-quality research" aimed at improving workers' compensation systems.
The study was limited to worker's compensation claims of seven days or more of lost work time who received physical therapy for low back pain only. To ensure they were examining data from similar patients, authors excluded any claims that had "red flag" conditions such as fracture, nerve pain, neck conditions, comorbid conditions with complications, and surgeries. They also excluded claims that included chiropractic care.
Authors broke down timing of initial physical therapy into five groups. Early physical therapy took place within three days, between four and seven days, or between eight and 14 days of symptom onset. Late physical therapy was initiated between 15 and 30 days or after 30 days. Some of the biggest contrasts in outcomes were evident between the earliest and latest timing.
Here are some key findings from the report:
- Patients who received late physical therapy had higher use of medical services and higher average payment per claim for all medical services, compared with those who received early physical therapy. The average payment per claim for people initiating physical therapy after 30 days from injury was 24%-28% higher than for those who received early physical therapy.
- Compared with patients who received physical therapy within three days of injury, those who initiated physical therapy more than 30 days after injury were 47% more likely to have an MRI, 46% more likely to be prescribed opioids, 29% more likely to receive injections for pain management, and 89% more likely to have back surgery.
- The average number of disability weeks claimed by people who initiated physical therapy more than 30 days after injury was 58%-69% higher than the number reported by those who received physical therapy within seven days of injury.
- There was a strong correlation between timing of physical therapy and the type of care setting. Of the people who received physical therapy within three days, 72% received services from a therapist affiliated with the same organization as their referring physician.
- The timing of physical therapy may have been influenced by a delay in seeing the initial provider, differences in physician practice patterns, or access to a facility providing PT services.
"The findings of our study support the value of ordering PT early rather than late, suggesting that clinicians and payors should be encouraged to work proactively to remove barriers to early [physical therapy]," write authors, who also note the need for high-quality randomized controlled trials to provide further evidence.
Wanda Evans, PT, DPT, MHS, APTA senior payment specialist, says the findings are an important addition to the growing support for getting to a PT early for LBP.
"The study wanted to determine if timely physical therapy mattered in workers' compensation, and the answer was a resounding 'absolutely,'" Evans said. "Workers' compensation patients fall into the category of occupational medicine, where cost control of medical expenditures and rates for return to work are key metrics that employers monitor. The findings of this report speak directly to those concerns and show that physical therapy can play a crucial role in workers' compensation."
The study joins a growing body of research supporting the use of early physical therapy for LBP, including a systematic review that analyzed 11 separate studies, an APTA co-sponsored study that found lower rates of later opioid use among patients who received early physical therapy for LBP, and research from 2018 that showed cost savings (as well as lower later opioid use) when patients with LBP saw a PT first.