Original articleInitial Management Decisions After a New Consultation for Low Back Pain: Implications of the Usage of Physical Therapy for Subsequent Health Care Costs and Utilization
Section snippets
Patients
We included patients with a new LBP consultation from 2004 to 2008 from 1 of 4 community-based primary care clinics in Salt Lake City, Utah, operated by Intermountain Healthcare, a private, nonprofit, integrated health care system. Each primary care clinic shared space with an Intermountain physical therapy clinic. The study was approved by the Institutional Review Board at Intermountain Healthcare.
We identified patients with a primary care visit at an included clinic using claims data from
Results
A total of 2532 patients with a new LBP-related primary care consultation were identified, and 2184 (86.2%) met all inclusion criteria (table 1). Reasons for exclusion are outlined in figure 1. The most common initial management strategies were opioid (n=869, 39.8%) and muscle relaxant (n=802, 36.7%) medications. Physical therapy was utilized for initial management with 286 patients (13.1%). The first session occurred mean ± SD 5.6±4.1 days after the index visit, and 3.9±3.2 sessions were
Discussion
This study combined claims and EMR data to evaluate physical therapy as an initial management strategy after a new primary care LBP consultation. We found that initial physical therapy management occurred after 13.1% of consultations, and was more likely in patients without hypertension or a prior lumbar surgery who were not prescribed opioids. Controlling for patient characteristics and other initial management strategies, initial physical therapy was not a determinant of total LBP-related
Conclusions
These findings support the opinion that initial management decisions after a new LBP consultation are consequential with respect to additional health care use and costs, and should be the subject of additional research. We did not find support for the concern that early physical therapy would significantly increase costs or utilization of additional care. Further research is needed combining costs with patient-centered outcomes measures to determine the value associated with initial management
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