Subsequent healthcare utilization associated with early physical therapy for new episodes of low back pain in older adults.

Publication Type:

Journal Article


The spine journal : official journal of the North American Spine Society (2016)


BACKGROUND: The association between early physical therapy (PT) and subsequent healthcare utilization following a new visit for low back pain is not clear, particularly in the setting of acute low back pain.

PURPOSE: 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.

STUDY DESIGN/SETTING: Prospective cohort study. Data were collected at 3 integrated health care systems in the United States through the Back Pain Outcomes using Longitudinal Data (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.

OUTCOME MEASURES: Primary outcome was total back-pain-specific relative value units (RVUs), from days 29-365. Secondary outcomes included overall RVUs for all healthcare 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 and opioid use.

METHODS: We compared patients that had early PT (initiated within 28 days of the index visit) to those not initiating early PT using appropriate, generalized linear models to adjust for potential confounding variables. BOLD was funded by an Agency for Healthcare Research and Quality grant, R01 HS019222-01. The authors report no potential conflict of interest related to this study.

RESULTS: Adjusted analysis found no statistically significant difference in total spine RVUs between the two groups (ratio of means 1.19, 95% CI of 0.72 to 1.96, p=0.49). For secondary outcomes, only the difference between total spine imaging RVUs and total PT RVUs was statistically significant. The early PT group had greater PT RVUs, the ratio of means was 2.56 (95% CI of 2.17-3.03, p<0.001.) The early PT group had greater imaging RVUs, the ratio of means was 1.37 (95% CI of 1.09-1.71, p=0.01.) CONCLUSIONS: We found that, in a group of older adults presenting for a new episode of low back pain, the use of early PT is not associated with any statistically significant difference in subsequent back-pain-specific healthcare utilization compared to patients not receiving early PT.