This article is more than 5 years old. Information may no longer be current.
Similar health care utilization seen between patients who had early PT vs no early PT for back pain
Researchers found no statistical difference in use of subsequent back pain-specific health care between older patients who had early physical therapy for new episodes of low back pain and those who did not have early physical therapy.
Using the Back-Pain Outcomes using Longitudinal Data registry, researchers performed a prospective study of 4,723 patients who were at least 65 years old and presented with new low back pain episodes. Investigators calculated the total back pain-specific relative value units (RVUs) between 29 days and 365 days. Other outcomes included the health care RVUs overall and RVUs from specific health care services, such as imaging, emergency department visits, physician visits, physical therapy, spinal injections, spinal surgeries and opioid use. Patients who underwent early physical therapy (PT; given within 28 days of the first visit) were compared with patients who did not undergo early PT with generalized linear models.
Findings showed patients with early PT were not statistically significantly different than those without PT with regard to the total spine RVUs. Investigators noted the only statistically significant difference seen between the groups was between the total spine imaging RVUs and total PT RVUs. Greater PT RVUs were seen in the early PT group, with a ratio of means of 2.65, and the early PT patients also had greater imaging RVUs, with a ratio of means of 1.37. ‒ by Monica Jaramillo
Disclosures: The study was funded by the Agency for Healthcare Research and Quality. Please see the full study for a list of all other financial disclosures.
Perspective
Back to Top
This study examines whether early physical therapy for adults aged older than 65 years presenting to a primary care physician with low back pain is associated with back-related health care utilization during a 1-year follow-up. It is suggested in clinical guidelines that early intervention beyond advice is unnecessary or even detrimental if excessive investigation and treatment is provided for a condition considered to have a good natural recovery. In this study, however, approximately half of the patients had persistent low back pain (> 3-month duration), while more than 60% had leg pain at their initial presentation, which are stronger indications for more intensive treatment.
Although no causation can be implied by an observational study, the analysis controlled for several important confounders, such as duration of symptoms, pain intensity, disability, recovery expectations, anxiety and depression, with results showing no association between early commencement of physical therapy and future back-related health care utilization. While it is reassuring that early referral to physical therapy might not lead to a future burden for the health system, the challenge remains to determine which physical therapy treatment approaches (if any) are clinically beneficial and cost-effective for elderly patients who present with low back pain.