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Subsequent Healthcare Utilization after Early Physical Therapy for Low Back Pain in Older Adults

This study explores the association between initiating early physical therapy for new episodes of low back pain in older adults and subsequent healthcare utilization. The results show that early physical therapy is not associated with any difference in subsequent back-pain-specific healthcare utilization compared to patients who did not receive early physical therapy.

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Subsequent Healthcare Utilization after Early Physical Therapy for Low Back Pain in Older Adults

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  1. Subsequent Healthcare Utilization Associated With Early Physical Therapy for New Episodes of Low Back Pain in Older Adults DevenKarvelas, MD University of Michigan 10/04/2015, AAPM&R Annual Assembly

  2. Disclosures and Funding Disclosures – None Funding Source – Agency for Healthcare Research and Quality • $10 million ARRA CHOICE award - 1R01HS019222-01 • Back Pain Outcomes Using Longitudinal Data (BOLD) • PI: Jerry Jarvik, MD, MPH • Details: www.backpainproject.org This is a prospective cohort study (Level 1 Evidence)

  3. acknowledgements Sean Rundell Janna Friedly Alfred Gellhorn Laura Gold Bryan Comstock Patrick Heagerty Brian Bresnahan David Nerenz Jeffrey Jarvik

  4. Low back pain Background Lifetime incidence between 60% and 85% Accounts for a substantial portion of our annual healthcare expenditures Physical therapy is a commonly-prescribed treatment Optimal timing of physical therapy is not clear Two prior studies (Gellhorn et al and Fritz et al) found early PT was associated with a decrease or no change in subsequent healthcare utilization

  5. Study objective To estimate the association between initiating early physical therapy following a new visit for an episode of low back pain and subsequent back-pain-specific health care utilization in older adults after adjusting for disease severity, symptom duration and sociodemographic factors.

  6. Design Design: Prospective cohort study in 3 major integrated healthcare systems (BOLD registry) Patient sample: 4,723 adults, aged 65 and older, presenting to a primary care setting with a new episode of low back pain Intervention: Patients who had early PT (within 28 days of index visit) Comparator: Patients who didn’t have early PT Sub-analysis: Patients with a self-reported symptom duration of less than one month

  7. Outcomes Primary outcome: Total back-pain-specific relative value units (RVUs), from days 29-365 Secondary outcomes: Overall RVUs for all healthcare use and use of specific health care services including: Imaging (x-ray and MRI or CT) Emergency Department visits Physician visits Physical therapy Spinal injections Spinal surgeries Opioid use

  8. Analysis Adjustment performed with generalized linear models All models adjusted for age, sex, race, ethnicity, education, marital status, smoking status, duration of back pain, back-related disability, back pain NRS, leg pain NRS, expectations for recovery, anxiety symptoms, depression symptoms, EQ-5D, study site, and total RVUs for the 365 days prior to the index visit.

  9. Results

  10. Results

  11. Results

  12. Results Acute low back pain sub-analysis: 246 participants with early PT and 1348 without Performed for primary outcome only No statistically significant difference noted Ratio of means 2.01, 95% CI 0.98 to 4.15, P 0.06. Exploratory analysis: Total spine RVUs from day 1-365 Performed to include PT RVUs from first month Similar results to primary analysis Ratio of means 1.13, 95% CI 0.76 to 1.70, P 0.54

  13. Discussion Early PT was not associated with any meaningful change in subsequent healthcare utilization This was true even when the RVUs for the initial PT were included Early PT specifically for acute LBP also is not associated with any change in subsequent back-pain-specific healthcare utilization

  14. Discussion Rundell, et al.: Functional outcomes after early PT in BOLD Modest improvement in the primary outcome (RMDQ) in patients who had early PT (mean RMDQ 1.4 points less) Early PT may lead to modestly improved outcomes without an increase in overall healthcare utilization

  15. Conclusion In older adults presenting for a new episode of LBP, early PT is not associated with any difference in subsequent back-pain-specific healthcare utilization compared to patients not receiving early PT, even for patients with acute LBP.

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