Early physical therapy for low back pain reduces costs, resources

Physical therapist researchers John D. Childs, PT, PhD, et al analyzed 122,723 patients who went to a primary care physician following an initial LBP episode and received physical therapy within 90 days. Of these, 24% (17,175) received early physical therapy (within 14 days) that adhered to guidelines for active treatment. During a 2-year time period, these patients made significantly less use of advanced imaging, lumbar spinal injections, lumbar spine surgery, and opioids than did patients in other combinations of timing and adherence. Early physical therapy patients also had 60% lower LBP-related costs as compared to 33.5% (23,993) of patients who had delayed and adherent physical therapy (between 14 and 90 days). Patients received physical therapy within the Military Health System, one of the largest single payer health systems in the United States.

"Physical therapy as the starting point of care in your low back pain episode can have significant positive implications," Childs explained. "Receiving physical therapy treatment that adheres to practice guidelines even furthers than benefit."

Clinical guideline recommendations in military and civilian settings are to avoid opioids and advanced imaging procedures as a first-line of treatment. However, research done mainly in civilian settings reveals that clinical practice is inconsistent with these recommendations. According to Childs, the study's results extend the findings from civilian settings by demonstrating an association between early guideline adherent care, costs, and use of health care resources in a single-payer health system.

Initial management following a new episode of low back pain can have profound implications for health care utilization and costs. According to American Physical Therapy Association President Paul Rockar Jr, PT, DPT, MS, "Given the enormous burden of excessive and unnecessary treatment for patients with low back pain, cost savings from physical therapy at the beginning of care has important implications for single-payer health care systems."