Physical therapy as first approach may effectively treat acute back, neck pain

St. Luke’s University Health Network announced the launch of Comprehensive Spine, a physical-therapy-first approach program for the treatment of acute back and neck pain.

Designed to avoid costly ER visits, radiographs, opioid prescriptions and unnecessary surgeries, Comprehensive Spine was established when members of St. Luke’s University Health Network realized back and neck pain were one of the most common diagnoses that presented at the network and that patients were entering the system through various departments, according to Aldo Carmona, MD, senior vice president for clinical integration for St. Luke’s University Health Network.

Roberta McMichael

“The approach was not always standardized. Many people were doing a decent job trying to get people to where they needed to go, but what was hard, as you can imagine when the entry points are so many, [was for] the network to get a handle on how these patients were being treated,” Carmona told Healio.com/Orthopedics. “What we have attempted to do is to essentially be a resource for patients and for physicians to get funneled into a standardized program where we have researched best practices and started people on early and effective physical therapy as the primary goal and avoiding a lot of other issues.”

Providing appropriate treatment

Implementation of a physical-therapy-first approach can make access to patient care less complicated, according to Carmona, by making sure patients are being seen by appropriate physicians. At St. Luke’s University Health Network, 50% of patients who presented with acute low back pain entered through the emergency department or urgent care, he said.

“What we want to do is create a way for patients to access, even if they have to go into an emergency department, for them to be triaged appropriately to one of our specialized physical therapy sets,” Carmona said.

By providing a single phone number for the Comprehensive Spine program, Carmona noted patients can be identified as low risk, high risk or intermediate risk of key medical issues through standardized questionnaires provided by a specialized nurse.

“If a patient is high risk for anything, any kind of medical issue, we will appropriately triage them to the right person, whether that be to an emergency room or to a surgeon’s office,” Carmona said.

Effective treatment

Similar to the process used at St. Luke’s University Health Network, a multidisciplinary team at the Virginia Mason Spine Clinic in Seattle has optimized the care of patients with low back and neck pain, which sends them to “the right provider at the right time during their journey of care, with the least amount of cost and the highest amount of effectiveness,” Roberta McMichael, PT, DPT, OCS, physical therapist and clinical specialist at the Virginia Mason Spine Clinic, told Healio.com/Orthopedics.

Through an educational approach, she said patients receive tools to manage their symptoms and learn appropriate exercises and self-care to prevent their pain from becoming chronic.

“The physical-therapy-first approach has been proven to be an effective, empowering treatment paradigm or design where patients can get easy access with quality care with a provider who is able to screen them for any more recent medical conditions and appropriately refer them,” McMichael said.

Benefits of physical therapy

Besides supplying the patient with the appropriate care in a timely manner, studies have shown cost savings to both patients and the health care system with a physical-therapy-first approach vs. usual care, McMichael said.

“When a person comes to a physical therapist first, there is a much lower incidence of them moving on to getting advanced imaging, such as an MRI/CT scan. They have a much lower incidence of ending up getting injections which may or may not be helpful for them, and much lower incidence of going on to surgery,” she said.

Carmona noted a physical-therapy-first approach may also help reduce the consumption of opioids by providing narcotic-free medications for shorter courses.

“[Acute back or neck pain is] a common problem, oftentimes treated aggressively, sometimes inappropriately,” Carmona said. “It is, as usual, start with things that do less harm, start with medications that are the safest, leave the heavy guns and the heavy therapies for when things are not working. Frankly, 90% of it should be easily treated with good physical therapy, good short courses of medication and just good education and taking care of people.”

Ways to implement

To institutions that want to implement a physical-therapy-first approach for back and neck pain management, Carmona said, “Do your homework.”

“This was not just a program we thought up and put together on paper,” he said. “If it is going to work, you have to have a tremendous amount of coordination, a tremendous amount of buy-in, a tremendous amount of education for providers and for patients.”

It is also important to ensure everyone is on board with the implementation, including the information technology department, the hospital and network and the physical therapy department, he said.

According to McMichael, physical therapists should create rapport with other referral sources and have data to prove their treatment methods are efficacious.

“It is valuable to have the appropriate triage tools to help ensure our patients are best served by the appropriate providers,” McMichael said. – by Casey Tingle

References:

St. Luke’s launches new Comprehensive Spine program. Available at: https://www.slhn.org/news/2018/st-lukes-launches-new-comprehensive-spine-program. Accessed Aug. 22, 2018.

www.virginiamason.org/spine-clinic

For more information:

Aldo Carmona, MD, can be reached at 801 Ostrum St., Bethlehem, PA 18015; email: samuel.kennedy@sluhn.org.

Roberta McMichael, PT, DPT, OCS, can be reached at 1100 Ninth Ave., Seattle, WA 98101; email: gale.robinette@virginiamason.org.

Disclosures: Carmona and McMichael report no relevant financial disclosures.