The value of physiotherapy

Abstract

Study Design. Retrospective cohortObjective. To describe physical therapy utilization following primary care consultation for low back pain (LBP) and evaluate associations between the timing and content of physical therapy and subsequent healthcare utilization and costs.Summary of Background Data. Primary care management of LBP is highly variable and the implications for subsequent costs are not well-understood. The value of referring patients from primary care to physical therapy has been debated, and information on how the timing and content of physical therapy impact subsequent costs and utilization is needed.Methods. Data were extracted from a national database of employer-sponsored health plans. 32,070 patients with a new primary care LBP consultation were identified and categorized based on the use of physical therapy within 90 days. Patients utilizing physical therapy were further categorized based on timing (early (within 14 days) or delayed) and content (guideline adherent or non-adherent). LBP-related healthcare costs and utilization in the 18-months following primary care consultation were examined.Results. Physical therapy utilization was 7.0% with significant geographic variability. Early physical therapy timing was associated with decreased risk of advanced imaging (OR = 0.34, 95% CI: 0.29, 0.41), additional physician visits (OR = 0.26, 95% CI: 0.21, 0.32), surgery (OR = 0.45, 95% CI: 0.32, 0.64), injections (OR = 0.42, 95% CI: 0.32, 0.64), and opioid medications (OR = 0.78, 95% CI: 0.66, 0.93) as compared with delayed physical therapy. Total medical costs for LBP were $2736.23 lower (95% CI: 1810.67, 3661.78) for patients receiving early physical therapy. Physical therapy content showed weaker associations with subsequent care.Conclusion. Early physical therapy following a new primary care consultation was associated with reduced risk of subsequent healthcare compared with delayed physical therapy. Further research is needed to clarify exactly which patients with LBP should be referred to physical therapy; however if referral is to be made, delaying the initiation of physical therapy may increase risk for additional healthcare consumption and costs.