Article Figures & Data
Figures
- Figure 1.
Participants within a Medicaid Managed Care Low-Back Pain Cohort presenting to primary care (January 1, 2012 to December 31, 2013).
Tables
- Table 1.
Baseline Characteristics of a Medicaid Managed Care Low-Back Pain Cohort Presenting to Primary Care (January 1, 2012 to December 31, 2013)
Variable All Patients (n = 454) Consult Status Participation Status Among Those with Consults PT Consult (n = 215) No PT Consult (n = 239) P-Value PT (n = 81) No PT (n = 134) P-value Demographic variables Age (years), mean (SD) 40.4 (12.0) 37.3 (11.7) 43.1 (11.6) .00 39.9 (12.02) 35.8 (11.3) .01 Female 321 (70.7%) 160 (74.4%) 161 (67.4%) .12 57 (70.4%) 103 (76.9%) .33 Depression 138 (30.4%) 53 (24.7%) 85 (35.6%) .01 23 (28.4%) 30 (22.4%) .33 Chronic pain 129 (28.4%) 40 (18.6%) 89 (37.2%) .00 12 (14.8%) 28 (20.9%) .29 Obesity 102 (22.5%) 44 (20.5%) 58 (24.3%) .37 17 (21.0%) 27 (20.1%) 1.00 Smoker 106 (23.3%) 33 (15.3%) 73 (30.5%) .00 11 (13.6%) 22 (16.4%) .70 Charlson CCI .00 CCI < 2 245 (54.0%) 148 (68.8%) 97 (40.6%) 45 (55.6%) 103 (76.9%) <.01 CCI 2 to 3 130 (28.6%) 48 (22.3%) 82 (34.3%) 28 (34.6%) 20 (14.9%) CCI > 3 79 (17.4%) 19 (8.8%) 60 (25.1%) 8 (9.9%) 11 (8.2%) Prior opioid prescription (within 90 days of index) 99 (21.8%) 42 (21.8%) 57 (25.7%) .40 9 (12.3%) 33 (27.5%) .02 Procedure variables at index visit X-ray at index visit 75 (16.5%) 44 (20.5%) 31 (13.0%) .04 24 (29.6%) 20 (14.9%) .01 MRI at index visit 2 (0.4%) 0 2 (0.8%) — 0 0 — Additional orders 75 (16.5%) 35 (16.3%) 40 (16.7%) 1.00 8 (9.9%) 27 (20.1%) .06 Consult to Specialty care 61 (13.4%) 3 (1.4%) 58 (24.3%) .00 0 (0%) 3 (2.2%) .30 Consult for advanced imaging 19 (4.2%) 2 (0.9%) 16 (7.1%) .001 1 (1.2%) 1 (0.7%) 1.00 Opioid prescription 113 (24.9%) 50 (25.95) 63 (28.4%) .58 14 (19.2%) 36 (30.0%) .13 NSAID prescription 96 (21.1%) 56 (29.05) 40 (18.0%) .01 20 (27.4%) 36 (30.0%) .75 Muscle relaxant prescription 51 (11.2%) 35 (18.1%) 16 (7.2%) .001 9 (12.3%) 26 (21.7%) .12 CCI, Co-Morbitiy Index; MRI, magnetic resonance imaging; NSAID, non-steroidal anti-inflammatory; PT, physical therapy; SD, Standard Deviation.
- Table 2.
Predictors of Receiving a Physical Therapy Consult within a Medicaid Managed Care Low-Back Pain Cohort Presenting to Primary Care (January 1, 2012 to December 31, 2013): Multivariate Logistic Regression Modeling Blocks and Parameter Estimates for Predictors
Predictor Variable B aOR (95% CI) P-Value for Predictor Nagelkerke R2 P-Value for Block Age (years) −0.02 0.98 (0.96 to 1.00) .17 0.07 .00 Sex (female) −0.15 0.86 (0.52 to 1.4) .55 Comorbidities 0.17 .00 Depression −0.23 0.79 (0.48 to 1.32) .33 Chronic pain −0.32 0.73 (0.43 to 1.25) .25 Obesity −0.22 0.80 (0.47 to 1.36) .41 Tobacco use −0.65 0.52 (0.30 to 0.91) .02 2 or more on the Charlson −0.86 0.42 (0.23 to 0.78) .01 Index procedures 0.36 .00 X-ray 0.59 1.81 (0.97 to 3.36) .06 Referral for specialty care or advanced imaging −3.47 0.03 (0.01 to 0.09) .00 Index prescriptions 0.39 .00 NSAID drugs 0.60 1.81 (1.00 to 3.27) .05 Muscle relaxers 0.81 2.24 (1.03 to 4.87) .04 aOR, adjusted odds ratio; CI, confidential interval; CCI, Co-Morbidity Index; NSAID, non-steroidal anti-inflammatory.
- Table 3.
Predictors of Physical Therapy Participation within a Medicaid Managed Care Low-Back Pain Cohort Presenting to Primary Care and Receiving a Physical Therapy Consult (January 1, 2012 to December 31, 2013): Multivariate Logistic Regression Modeling Blocks and Parameter Estimates for Predictors
Predictor Variable B aOR (95% CI) P-Value for Predictor Nagelkerke R2 P-Value for Block Age −0.01 0.99 (0.96 to 1.02) .73 0.07 .00 Sex (female) −0.10 0.90 (0.45 to 1.80) .77 X-ray at index 0.97 2.63 (1.25 to 5.53) .01 0.23 .00 Multiple orders at index −1.28 0.28 (0.11 to 0.70) .01 2 or more comorbidities 1.08 2.96 (1.20 to 7.20) .02 Prior opioid prescription (within 90 days) −0.89 0.38 (0.17 to 0.83) .02 aOR, adjusted odds ratio; CI, confidential interval.
- Table 4.
Healthcare Utilization within a Medicaid Managed Care Low-Back Pain Cohort Presenting to Primary Care (January 1, 2012 to December 31, 2013) by Physical Therapy (PT) Consult Status and by PT Participation Status
Care Beyond Index Visit All Patients (n = 454) PT Consult (n = 215) No PT Consult (n = 271) P-Value PT Participants (n = 81) Non-PT Participants (n = 134) P-Value X-rays 79 (17.4%) 37 (17.2%) 42 (17.6%) 1.00 13 (16.0%) 24 (17.9%) .85 Advanced imaging 48 (10.6%) 17 (7.9%) 31 (13.0%) .09 13 (16.0%) 4 (3.0%) .00 Spinal injection 22 (4.8%) 6 (2.8%) 16 (6.7%) .08 4 (4.9%) 2 (1.4%) .20 Surgery 3 (0.7%) 0 3 (1.3%) .25 0 0 — Emergency department 59 (13%) 33 (15.3%) 26 (10.9%) .17 7 (8.6%) 26 (19.4%) .05 Opioid Rx during followup 192 (42.3%) 78 (40.4%) 114 (51.4%) .03 21 (28.8%) 57 (47.5%) .01 Number in bold represent significant between group differences.
PT, Physical Therapy; Rx, prescription.
Diagnosis ICD-9 Code Conditions included Low back pain 720.2 721.3 722.1 722.52 722.73 722.93 724.x 739.3 739.4 756.11 756.12 846.x 847.2 847.3 847.9 Red flag conditions requiring urgent management (excluded) Urinary tract infection 599.0 Kidney or gallbladder stones 592.x 574.x Malignant neoplasm 140.x to 209.x Fracture or stress fracture of spine or pelvis 805.x to 809.x
820.x to 821.x
733.13 to 733.15 or 733.96 to 733.98Osteomyelitis 733.x Cauda equina syndrome 344.6x Conditions likely to impact the ability to access outpatient services (excluded) Hemiplegia, paraplegia, quadriplegia or wheelchair dependence 344.0x to 344.1x 344.8x to 344.9x 438.2x to 438.5x End-stage renal disease 403.01
403.91 585.5x to 585.6x
V45.11Comorbidities Mental health conditions 296. to 298.x
300.x
301.x
308.x
309.x
311.xChronic pain 338.x Substance use disorders 291.x
303.x to 304.x
305.0
305.2x to 305.9x
648.3Smoking status 305.1
V15.82
649.0xObesity 278.x
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