PT Tip of the Month

Importance of Physical Therapy in the Treatment of Low Back Pain

A newly published study in the March journal of Health Service Research has concluded that patients who receive a referral to physical therapy from their primary care provider (PCP) require less health care utilization and costs when compared to those referred to imaging as a first step.

Researchers Julie Fritz, PT, PhD, FAPTA, Gerard Brennan, PhD, and Stephen Hunter, PT, PhDm OCS pulled health care records and data for 841 patients who consulted their PCP for complaints of low back pain and received referrals within 6 weeks outside of primary care. Of these individuals, 385 patients were sent on to received imaging, while 377 were sent to PT. (79 were excluded as they were sent on to specialists or chiropractors.)

After following these individuals and their utilization of services, Fritz and her colleagues concluded that physical therapy was a less costly approach. The cost of physical therapy, for an average of 3.8 visits was $504, compared to a staggering $1,306 average cost for those who received MRIs. These patients were then tracked over the next year to determine if other services were needed. For the physical therapy group, subsequent costs over this year were 66% lower ($1,871 PT group vs $6,664 MRI group) regardless of health history such as prior surgeries, use of medications, osteoporosis, and mental health issues. Those who received imaging initially were often directed down different paths. The study reports a referral to imaging “increased offs of surgery, injections, specialist, and emergency department visits within a year.” The authors theorized that perception of imaging results frequently labeled and categorized patients by their diagnosis heightening concerns in both patients and providers, causing additional medical care seeking and treatment.

How does this relate to me?

While most individuals in Massachusetts are covered by health insurance, patients are still required to meet deductibles and provided copays, transferring the burden of these health care costs to you when they may be unnecessary. Furthermore, our community benefits from reduced financial burdens of our health care system.

But, did physical therapy work?

While this particular study did not examine patient function and satisfaction following physical therapy, many studies have. A study by the same author published in the December 2012 issue of Spine showed that early physical therapy treatment for low back pain decreased necessity of testing such as MRIs, the use of drugs or injection and surgery. This study sampled 32,070 patients who consulted their PCP for low back pain. A correlation was also found showing those who were seen by a physical therapist within 14 days of referral had reduced odds of further health care utilization and costs compared to those who delayed treatment within 14 to 90 days of the PCP visit. Fritz states, “the value of referring patients to physical therapy who are newly consulting primary care physicians for low back pain likely depends on the timing of the referral and how patients adhere to physical therapy guidelines that recommend maintaining and improving activity levels.” One possible connection between early care and positive outcomes may be that a physical therapist can help to promote a greater sense of self-reliance in managing pain and confidence in a positive outcome. She concludes, “If a physical therapist’s treatment assists in developing self- efficacy, it is reasonable to expect it would have greater impact when implemented very early, before negative expectations have become reinforced and entrenched.”

What will I do in physical therapy?

In 2012, the Journal of Orthopaedic & Sports Physical Therapy released a paper in an effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with low back pain. In this study over 300 separate research articles were compiled and analyzed to determine which treatments have been shown to be most effective. The practice guidelines highly support the use of an active approach in the treatment of low back pain for ways to maintain and improve activity level and function. An active approach included therapeutic exercise, neuromuscular reeducation, and patient education of self-management. Minimizing the use of passive modalities such as heat, ultrasound, electric stimulation, and massage was also recommended. Lastly, the use of manual therapy with mobilizations and manipulations was recommended and most effective when used early in treatment in conjunction with active interventions. Patients who were guided through treatment adhering to the recommended practice guidelines also had a decreased likelihood of needing surgery or drugs and injections. For patients receiving a treatment adherent to the guidelines total back pain costs were an average of $1,374.30 lower than those with non-adherent physical therapy.

At Beantown Physio, we value the importance of continued education and staying up to date with research and literature to provide our patients with the best care. Our therapists adhere to the practice guidelines and emphasis patient education and an active approach in all treatment plans, especially for low back pain. Self-management and exercise is always addressed as early as the initial visit. Exercises for core stabilization, core strengthening, spinal stabilization, and lower extremity conditioning are introduced early in the treatment plan and adjusted on an individual basis depending on patient’s needs and abilities. Appropriate manual therapy such as soft tissue mobilization, stretching, and mobilizations are used in conjunction with the active approach based on each patient’s needs as well. Passive treatments such as heat, ultrasound, and electric stimulation are used sparingly, but as needed.

If you are experiencing signs and symptoms of low back pain and would like to be scheduled for a physical therapy evaluation, please call 617-232-PAIN (7246) for our Brookline office or 617-325-PAIN (7246) for our West Roxbury office.

References:

  1. Fritz JM, Brennan GP, Hunter SJ. Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges. Health Serv Res. 2015;
  2. Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs. Spine. 2012;37(25):2114-21.
  3. Delitto A, George SZ, Van dillen LR, et al. Low back pain Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2012;42(4):A1-57.

For previous PT Tips of the Month, visit the archive.

33 Pond Avenue, Suite 107B Brookline, MA 02445 Tel: (617) 232-PAIN (7246) Fax: (617) 232-5196
1208B VFW Parkway, Suite 202 West Roxbury, MA 02132 Tel: (617) 325-PAIN (7246) Fax: (617) 325-7282