Quicker treatment of low back pain leads to faster improvement and lower healthcare costs and utilization

"Low back pain is the fifth most common reason for all physician visits in the United States," says Michael Campian, DO who is a Physical Medicine and Rehabilitation resident at the University of Utah and an investigator on the study. Furthermore, healthcare costs related to low back pain are estimated to be as high as $238 billion annually, and the healthcare system is utilizing a number of methods to diagnose and treat the condition -- from opioid use to expensive radiographs/advanced imaging to injections and surgery. We initiated this study to improve the care and satisfaction of people living with low back pain while attempting to reduce healthcare utilization and costs associated with its management."

To address these issues, a team of physicians (Pamela Hansen, MD; Michael Campian, DO; Tyler Hedin, MD) , physical therapists (Julie Fritz, PT, PhD; Kim Cohee, DPT; Jake Magel, PT, DSc) and a hospital administrator (Matthew Huish, MBA), created a protocol that allows patients who typically have a four-to-six week wait time to see a PM&R spine specialist, to begin immediate (within 72 hours) treatment from a physical therapist while they are awaiting their appointment with the spine specialist.

"Physical therapy is important because we know that maintaining a normal lifestyle (i.e., continuing to work), staying active and early participation in an exercise program is extremely valuable in the management of low back pain," says Dr. Campian.

The rapid access protocol (RAP) created by the researchers allows patients whose insurance covers physical therapy without a physician referral to undergo screening with a physical therapist and begin treatment as quickly as possible. During the initial screening, the physical therapist looks for any red flags that will need the spine specialist's immediate attention. These include fevers, chills, unintentional weight loss, progressive neurologic symptoms, history of trauma to the back, or pain so severe they are unable to tolerate physical therapy. Barring any of these red flags, the patient will begin physical therapy immediately.

Since this spine research team initiated the RAP a little over one year ago, 93 patients have enrolled. On average, these patients' self-reported a greater improvement in physical function (e.g., ability to walk, sustain physical activity, etc.) compared to those not enrolled in RAP. Additionally, the patients enrolled in RAP required fewer X-Rays than patients not enrolled (23.8 percent vs. 65.6 percent). They also required fewer MRIs (3.6 percent vs. 21.1 percent) and injections (4.8 percent vs. 19 percent).

"Through RAP, patients can start addressing their low back pain immediately, which will hopefully allow them to avoid inactivity and prevent loss of work -- which has been demonstrated to negatively affect improvement of back pain -- ultimately improving or resolving their back pain," explains Dr. Campain of the initial success of the protocol. "This means they won't have to wait and see a physician whom routinely refers to physical therapy as a first line treatment in most of these cases."

Finally, the researchers noted that speeding the course of treatment and getting people functioning better earlier has potential to reduce healthcare costs. "Initially we set off to evaluate the success of rapid access to physical therapy in regards to improvement of low back pain and patient satisfaction, but we noted less frequent utilization of radiographs, MRIs and injections in these patients -- leading us to believe this protocol has the ability to reduce healthcare costs," explains Dr. Campain. "The next step would be to take a closer look at the reduction of healthcare cost with RAP, which is a significantly more complicated metric to evaluate."