Physical therapy for initial management of low back pain does not increase the risk for future healthcare needs.

4/23/2013

SALT LAKE CITY – Early physical therapy intervention for patients with low back pain may not add to the overall cost of their care, according to a new study by researchers at Intermountain Healthcare.

Researchers at Intermountain Healthcare Physical Therapy found that physical therapy for initial management of low back pain does not increase the risk for future healthcare needs such as surgery or increase the long-term costs of healthcare related to low back pain, according to the study published in Archives of Physical Medicine and Rehabilitation.

Low back pain is a major public health problem and a significant economic burden on individuals and society. It’s estimated that 80 percent of the population will experience back pain at some point in their lives.  The costs related to treating low back pain are very high.

“Most people who seek help for low back pain start with their primary care physician,” said Stephen Hunter, manager at Intermountain Physical Therapy. “Decisions made in that initial setting, like prescribing opioid medications, muscle relaxers, or physical therapy, are critical for the patient’s eventual outcome, but all of them come with some financial responsibility.” 

Researchers examined electronic medical records and insurance claims data of 2,184 patients who sought new primary care consultations for low back pain between 2004 and 2008 to determine which course of treatment was most effective for reducing the amount of healthcare required long-term.

According to the study, practice guidelines for primary care physicians generally advocate an initial strategy of helping patients to self-manage their pain, and the use of paracetamol, or nonsteroidal anti-inflammatory medications. There is debate about the value of referring the patient to physical therapy at this early time point or waiting a few weeks to allow the condition time to resolve on its own.

The argument against early use of physical therapy is that most patients with a new onset of low back pain improve rapidly through self-care and medication, making it likely that early physical therapy would only add to costs without improving outcomes.  Arguments for early physical therapy are that although most patients improve quickly, full recovery is elusive, recurrence is common, and early treatment may be the best time when the course of lower back pain can be effectively modified. Results of this study support this perspective that early physical therapy may help some patients avoid the need for additional care.

“While this study considered the decisions made at the initial point of discussion with a patient’s primary care physician, we hope this study will encourage additional research to identify the specific long-term costs and use of healthcare for patients pursing physical therapy earlier on in their course of treatment,” said Julie Fritz, PhD, PT, clinical outcomes research scientist at Intermountain Healthcare, and principal investigator of the study.

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