Low Back Pain: Early Physical Therapy Associated with Reduced Imaging, Invasive Procedures and ER Visits

PainRelief.com: What are the main findings?

Response: In our study, early initiation of physical therapy for U.S. patients with acute lower back pain (LBP) was associated with less health care resource use in the first month and in the first year after the initial onset of symptoms. These health care resources included advanced imaging, specialty appointments, epidural steroid injections and emergency room (ER) visits. Patients who began physical therapy early were half as likely to visit the ER within 30 days of symptom onset than those who did not receive early physical therapy, which we defined as starting within two weeks of symptom onset. Early initiation of physical therapy (PT) for U.S. patients with acute lower back pain (LBP) was associated with less health care resource use in the first month and the first year after the initial onset of symptoms, according to a new study by Johns Hopkins Medicine. These health care resources included advanced imaging, specialty appointments, epidural steroid injections and emergency room (ER) visits. Patients who began PT early were half as likely to visit the ER within 30 days of symptom onset than those who did not receive early PT, which the study defined as starting within two weeks of symptom onset.

PainRelief.com: What should readers take away from your report?

Response: Costs are a concern in a healthcare system with limited resources and increasing needs; however, they are not the only concern. A major concern is the avoidance of advanced imaging and invasive procedures, such as injections or surgery. In our study, at 30 days and 365 days following initial encounter, we were able to demonstrate decreased risk of advanced imaging, specialty visits, invasive procedures, and ED visits.

PainRelief.com: What recommendations do you have for future research as a result of this study?

Response: In our study, we sought to demonstrate the national experience with early physical therapy for patients with an episode of acute low back pain, to highlight the impact of early referral to physical therapy, and to examine the geographic distribution of needs versus resources. This information can inform the adoption of practice guidelines that call for early referral for patients whose symptoms are not resolving, support an episodic approach to healthcare payment models that would encourage early referral, and guide future work in digital physical therapy.

PainRelief.com: Is there anything else you would like to add?

Response: Healthcare needs and resources are not uniformly distributed across the geography of the United States. With our examination of regional variation, we hoped to spark a conversation on the inadequacy of the current distribution of physical resources to meet the needs of patients who are experiencing an acute episode of low back pain who could benefit from physical therapy care. It is hoped that, with advanced in digital physical therapy, these patients will be able to receive care that is matched to their needs in order to avoid unnecessary healthcare or opioid use in the future.

Citation:

Majd Marrache, Niyathi Prasad, Adam Margalit, Suresh K. Nayar, Matthew J. Best, Julie M. Fritz, Richard L. SkolaskyInitial presentation for acute low back pain: is early physical therapy associated with healthcare utilization and spending? A retrospective review of a National Database. BMC Health Services Research, 2022; 22 (1) DOI: 10.1186/s12913-022-08255-0

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