Low back pain affects nearly 70 million Americans and is considered the leading cause of disability in the United States. Costs associated with the condition exceed more than $100 billion each year.
A research team led by the University of Central Florida has evaluated how the use of physical therapy to treat acute low back pain ― and the timing of when treatment begins ― impact the use and costs of health care.
The researchers found that patients who started physical therapy within three days of receiving an acute low back pain diagnosis were less likely to use advanced imaging, specialist care and opioids than those who started physical therapy later.
The team’s findings were published online today in Physical Therapy Journal, the American Physical Therapy Association’s publication.
“Low back pain is the cause of significant pain, disability and loss of productivity,” said Xinliang Liu, who led the study as an assistant professor in the Department of Health Management and Informatics at UCF. “Decisions about treatment have important implications for the health care industry.”
Only a small percentage of patients with acute back pain are referred for physical therapy, according to Liu. And patients with physical therapy begin treatment at different times.
“There is no consensus about when to refer patients for physical therapy,” said William Hanney, a research team member and assistant professor of physical therapy at UCF. “The timing of physical therapy initiation remains controversial.”
The researchers addressed this controversy by examining insurance claims records for 46,914 patients in New York who had a new onset of acute low back pain from 2009 to 2014. They followed each patient’s records over one year starting with the date of diagnosis.
Among patients who had physical therapy, those who started treatment within three days of being evaluated (“immediate” treatment) were less likely to seek out more costly advanced imaging and specialist care than those who started physical therapy later.
Patients with immediate treatment were the least likely to have emergency room visits (27.37 percent). Nearly 33 percent (32.58 percent) of patients who had no physical therapy used emergency room services.
Patients with immediate treatment also were the least likely to fill a prescription for opioid medication (43.85 percent), followed by patients receiving no physical therapy (47.71 percent), patients receiving therapy 4-14 days later (53.99 percent) or 15-28 days later (61.29 percent).
The authors estimate that immediate referral to physical therapy for acute low back pain potentially could lead to a cost savings of more than $7 billion a year in the U.S.
“The impact of improving treatment of this condition is huge for all stakeholders ― patients, providers, public and private payers, and employers,” said Carolyn Watts, the Richard M. Bracken Chair and chairman for the Department of Health Administration at Virginia Commonwealth University, and a health services expert not associated with the study.
“This study represents the kind of research [that] policy and other decision makers need to create incentives to achieve the results,” she said.
Other members of the research team are Michael Masaracchio (Long Island University), Morey Kolber (Nova Southeastern University), Mei Zhao (University of North Florida), Aaron Spaulding (Mayo Clinic) and Meghan Gabriel (University of Central Florida). The study was funded by a grant from the New York Physical Therapy Association.
