Early physical therapy benefits low-back pain patients

Patients with low-back pain are better off seeing a physical therapist first, according to a study of 150,000 insurance claims. Analysis of 150K insurance claims shows health, cost upsides of starting care with a PT.

About 80 percent of adults experience back pain during their lifetimes, according to the National Institutes of Health. HeungSoon Pixabay

UW Medicine, University of Washington, May 23 2018

The study, published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit – but a 19 percent higher probability of hospitalization.

The authors noted that a higher probability of hospitalization is not necessarily a bad outcome if physical therapists are appropriately referring patients to specialized care when low back pain does not resolve by addressing potential musculoskeletal causes first.

These patients also had significantly lower out-of-pocket costs.

“Given our findings in light of the national opioid crisis, state policymakers, insurers, and providers may want to review current policies and reduce barriers to early and frequent access to physical therapists as well as to educate patients about the potential benefits of seeing a physical therapist first,” said lead author Dr. Bianca Frogner, associate professor of family medicine and director of the University of Washington Center for Health Workforce Studies.

Frogner said individuals in all 50 states have the right to seek some level of care from a physical therapist without seeking a physician referral, however, many do not take advantage of this option. She said this may be because some insurance companies have further requirements for payment.

Rather than being given painkillers, x rays and told to rest — a prevalent way of treating back pain,  Frogner said seeing a physical therapist first and doing prescribed exercise is a more proven method

Using an insurance claims dataset provided by the Health Care Cost Institute, the researchers reviewed five years of data of patients newly diagnosed with low-back pain who had received no treatment in the past six months. The claims were based in six states: Washington, Wyoming, Alaska, Montana, Idaho and Oregon. The study was funded by the Health Care Cost Institute State Health Policy Grant Program and the Laura and John Arnold Foundation.

“This study shows the importance of interprofessional collaboration when studying complex problems such as low back pain. We found important relationships among physical therapy intervention, utilization, and cost of services and the effect on opioid prescriptions,” said Dr. Ken Harwood, lead investigator for The George Washington University.

A similar study published in April in Physical Therapy aligned with these findings. A three-article series in The Lancet, on low back pain, also published in April, reported that too many patients are treated with surgery and pain medication as first-line treatments rather than more beneficial therapies employing exercise and cognitive behavioral therapy.

Source University of Washington


Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs, Bianca K Frogner PhD, Kenneth Harwood PhD PT CIE, C Holly A Andrilla MS, Malaika Schwartz MPH, Jesse M Pines MD MBA MSCE. Health Serv Res. 23 May 2018  doi: 10.1111/1475-6773.12984

  Further reading

Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs, Xinliang Liu, William J Hanney, Michael Masaracchio, Morey J Kolber, Mei Zhao, Aaron C Spaulding, Meghan H Gabriel. Physical Therapy, Volume 98, Issue 5, 1 May 2018,  doi: 10.1093/ptj/pzy023


Low back pain: a major global challenge, Stephanie Clark, Richard Horton


Low Back Pain Series The Lancet March 21, 2018

What low back pain is and why we need to pay attention, Jan Hartvigsen, Mark J Hancock, Alice Kongsted, Quinette Louw, Manuela L Ferreira, Stéphane Genevay, Damian Hoy, Jaro Karppinen, Glenn Pransky, Joachim Sieper, Rob J Smeets, Martin Underwood on behalf of the Lancet Low Back Pain Series Working Group

Prevention and treatment of low back pain: evidence, challenges, and promising directions, Nadine E Foster, Johannes R Anema, Dan Cherkin, Roger Chou, Steven P Cohen, Douglas P Gross, Paulo H Ferreira, Julie M Fritz, Bart W Koes, Wilco Peul, Judith A Turner, Chris G Maher on behalf of the Lancet Low Back Pain Series Working Group


Low back pain: a call for action, Rachelle Buchbinder, Maurits van Tulder, Birgitta Öberg, Lucíola Menezes Costa, Anthony Woolf, Mark Schoene, Peter Croft on behalf of the Lancet Low Back Pain Series Working Group

Also see
Early physical therapist treatment associated with reduced risk of healthcare utilization and reduced overall healthcare Medical Xpress

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