Primary Care Referral of Patients With Low Back Pain to Physical Therapy: Impact on Future Health Care Utilization and Costs

Fritz, Julie M.; Childs, John D.; Wainner, Robert S.; Flynn, Timothy W.

doi:10.1097/brs.0b013e31825d32f5

Cited by 259Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyMedical Practices and Rehabilitation

Primary Care Referral of Patients With Low Back Pain to Physical Therapy: Impact on Future Health Care Utilization and Costs

Fritz, Julie M., Childs, John D., Wainner, Robert S., Flynn, Timothy W.·2012·Spine

DOI 10.1097/brs.0b013e31825d32f5

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Abstract

STUDY DESIGN: A retrospective cohort. OBJECTIVE: To describe physical therapy utilization following primary care consultation for low back pain (LBP) and evaluate associations between the timing and content of physical therapy and subsequent health care utilization and costs. SUMMARY OF BACKGROUND DATA: Primary care management of LBP is highly variable and the implications for subsequent costs are not well understood. The importance of referring patients from primary care to physical therapy has been debated, and information on how the timing and content of physical therapy impact subsequent costs and utilization is needed. METHODS: Data were extracted from a national database of employer-sponsored health plans. A total of 32,070 patients with a new primary care LBP consultation were identified and categorized on the basis of the use of physical therapy within 90 days. Patients utilizing physical therapy were further categorized based on timing (early [within 14 d] or delayed)] and content (guideline adherent or nonadherent). LBP-related health care costs and utilization in the 18-months following primary care consultation were examined. RESULTS: Physical therapy utilization was 7.0% with significant geographic variability. Early physical therapy timing was associated with decreased risk of advanced imaging (odds ratio [OR] = 0.34, 95% confidence interval [CI]: 0.29, 0.41), additional physician visits (OR = 0.26, 95% CI: 0.21, 0.32), surgery (OR = 0.45, 95% CI: 0.32, 0.64), injections (OR = 0.42, 95% CI: 0.32, 0.64), and opioid medications (OR = 0.78, 95% CI: 0.66, 0.93) compared with delayed physical therapy. Total medical costs for LBP were $2736.23 lower (95% CI: 1810.67, 3661.78) for patients receiving early physical therapy. Physical therapy content showed weaker associations with subsequent care. CONCLUSION: Early physical therapy following a new primary care consultation was associated with reduced risk of subsequent health care compared with delayed physical therapy. Further research is needed to clarify exactly which patients with LBP should be referred to physical therapy; however, if referral is to be made, delaying the initiation of physical therapy may increase risk for additional health care consumption and costs.

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Studies have noted that ACT and PT reduce pain behaviors such as less sick leave and medical visits, whereas CBT prevents taking more sick leave and medical visits in the future.
“Studies have noted that ACT [36, 37] and PT [38] reduce pain behaviors such as less sick leave and medical visits whereas CBT prevents from taking more sick leave and medical visits in the future [39].”
From Effectiveness of a multidisciplinary rehabilitation program in real-world patients with chronic back pain: A pilot cohort data analysis (2021) · cites this paper as [38]

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Influential
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Background
Use of Physical Therapy for Low Back Pain by Medicaid Enrollees
Fritz, J. M., Kim, J., Thackeray, A., & Dorius, J. (2015) · Physical Therapy · doi:10.2522/ptj.20150037 · Cited by 43 · see citing works
Unrestricted Direct Access to Physical Therapist Services Is Associated With Lower Health Care Utilization and Costs in Patients With New-Onset Low Back Pain
Garrity, B. M., McDonough, C. M., Ameli, O., Rothendler, J. A., Carey, K., Cabral, H., Stein, M. D., Saper, R. B., & Kazis, L. E. (2019) · Physical Therapy · doi:10.1093/ptj/pzz152 · Cited by 42 · see citing works
Associations Between Early Care Decisions and the Risk for Long-term Opioid Use for Patients With Low Back Pain With a New Physician Consultation and Initiation of Opioid Therapy
Fritz, J. M., King, J. B., & McAdams-Marx, C. (2017) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000571 · Cited by 38 · see citing works
The Effects of Early Physiotherapy Treatment on Musculoskeletal Injury Outcomes in Military Personnel: A Narrative Review
Campbell, P., Pope, R., Simas, V., Canetti, E. F. D., Schram, B. L., & Orr, R. M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192013416 · Cited by 37 · see citing works
“[36] Retrospective cohort Patient (general population) data retrieved from U.”
Method
Value-Based Care for Musculoskeletal Pain: Are Physical Therapists Ready to Deliver?
Lentz, T. A., Goode, A. P., Thigpen, C. A., & George, S. Z. (2019) · Physical Therapy · doi:10.1093/ptj/pzz171 · Cited by 37 · see citing works
Effectiveness and Downstream Healthcare Utilization for Patients That Received Early Physical Therapy Versus Usual Care for Low Back Pain
Rhon, D. I., Miller, R. B., & Fritz, J. M. (2018) · Spine · doi:10.1097/brs.0000000000002619 · Cited by 36 · see citing works
Timing of physical therapy consultation on 1-year healthcare utilization and costs in patients seeking care for neck pain: a retrospective cohort
Horn, M. E., & Fritz, J. M. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3699-0 · Cited by 37 · see citing works
Impact of Risk Adjustment on Provider Ranking for Patients With Low Back Pain Receiving Physical Therapy
Deutscher, D., Werneke, M. W., Hayes, D., Mioduski, J. E., Cook, K. F., Fritz, J. M., Woodhouse, L. J., & Stratford, P. W. (2018) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2018.7981 · Cited by 35 · see citing works
Lesbian, Gay, Bisexual, and Transgender Inclusion in Physical Therapy: Advocating for Cultural Competency in Physical Therapist Education Across the United States
Copti, N., Shahriari, R., Wanek, L. J., & Fitzsimmons, A. (2016) · Journal of Physical Therapy Education · doi:10.1097/00001416-201630040-00003 · Cited by 35 · see citing works
Physiotherapy triage assessment of patients referred for orthopaedic consultation – Long-term follow-up of health-related quality of life, pain-related disability and sick leave
Samsson, K. S., & Larsson, M. E. H. (2014) · Manual Therapy · doi:10.1016/j.math.2014.06.009 · Cited by 33 · see citing works
Safety Events and Privilege Utilization Rates in Advanced Practice Physical Therapy Compared to Traditional Primary Care: An Observational Study
Mabry, L. M., Notestine, J. P., Moore, J. H., Bleakley, C., & Taylor, J. B. (2019) · Military Medicine · doi:10.1093/milmed/usz176 · Cited by 31 · see citing works
A Prospective Observational Study of Emergency Department–Initiated Physical Therapy for Acute Low Back Pain
Kim, H. S., Ciolino, J. D., Lancki, N., Strickland, K. J., Pinto, D., Stankiewicz, C., Courtney, D. M., Lambert, B. L., & McCarthy, D. M. (2020) · Physical Therapy · doi:10.1093/ptj/pzaa219 · Cited by 31 · see citing works
Physical therapy and opioid use for musculoskeletal pain management: competitors or companions?
George, S. Z., & Goode, A. P. (2020) · PAIN Reports · doi:10.1097/pr9.0000000000000827 · Cited by 32 · see citing works
Initial presentation for acute low back pain: is early physical therapy associated with healthcare utilization and spending? A retrospective review of a National Database
Marrache, M., Prasad, N., Margalit, A., Nayar, S. K., Best, M. J., Fritz, J. M., & Skolasky, R. L. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08255-0 · Cited by 30 · see citing works
“[19], who analyzed geographic variation of PT utilization within”
BackgroundResultInfluential
Subsequent health-care utilization associated with early physical therapy for new episodes of low back pain in older adults
Karvelas, D., Rundell, S. D., Friedly, J. L., Gellhorn, A. C., Gold, L. S., Comstock, B. A., Heagerty, P. J., Bresnahan, B. W., Nerenz, D. R., & Jarvik, J. G. (2016) · The Spine Journal · doi:10.1016/j.spinee.2016.10.007 · Cited by 29 · see citing works
First Provider Seen for an Acute Episode of Low Back Pain Influences Subsequent Health Care Utilization
Bise, C. G., Schneider, M., Freburger, J. K., Fitzgerald, G. K., Switzer, G. E., Smyda, G. W., Peele, P. B., & Delitto, A. (2023) · Physical Therapy · doi:10.1093/ptj/pzad067 · Cited by 30 · see citing works
Practice patterns when treating patients with low back pain: a survey of physical therapists
Davies, C. C., Nitz, A. J., Mattacola, C. G., Kitzman, P. H., Howell, D., Viele, K., Baxter, D. G., & Brockopp, D. Y. (2014) · Physiotherapy Theory and Practice · doi:10.3109/09593985.2013.877547 · Cited by 28 · see citing works
Timing of physical therapy for individuals with patellofemoral pain and the influence on healthcare use, costs and recurrence rates: an observational study
Young, J. L., Snodgrass, S. J., Cleland, J. A., & Rhon, D. I. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06768-8 · Cited by 28 · see citing works
Introduction of a psychologically informed educational intervention for pre-licensure physical therapists in a classroom setting
Ballengee, L. A., Covington, J. K., & George, S. Z. (2020) · BMC Medical Education · doi:10.1186/s12909-020-02272-5 · Cited by 27 · see citing works
What do patients referred to physical therapy for a musculoskeletal condition expect? A qualitative assessment.
Subialka, J. A., Smith, K., Signorino, J. A., Young, J., Rhon, D., & Rentmeester, C. (2022) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2022.102543 · Cited by 22 · see citing works
A value proposition for early physical therapist management of neck pain: a retrospective cohort analysis
Horn, M. E., Brennan, G. P., George, S. Z., Harman, J. S., & Bishop, M. D. (2016) · BMC Health Services Research · doi:10.1186/s12913-016-1504-5 · Cited by 26 · see citing works
Determining the impact of a new physiotherapist-led primary care model for back pain: protocol for a pilot cluster randomized controlled trial
Miller, J., Barber, D., Donnelly, C. A., French, S., Green, M., Hill, J. C., MacDermid, J. C., Marsh, J. D., Norman, K. E., Richardson, J. A., et al. (2017) · Trials · doi:10.1186/s13063-017-2279-7 · Cited by 26 · see citing works
Adherence to low back pain clinical practice guidelines by Saudi physical therapists: a cross-sectional study
Moslem, W. M., Alrwaily, M., & Almarwani, M. (2020) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2020.1806420 · Cited by 27 · see citing works
Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US
Harwood, K. J., Pines, J. M., Andrilla, C. H. A., & Frogner, B. K. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08092-1 · Cited by 26 · see citing works
“(S1 Table B) [26, 27].”
Does the implementation of clinical practice guidelines for low back and neck pain by physical therapists improve patient outcomes? A systematic review
Fillipo, R., Pruka, K., Carvalho, M., Horn, M. E., Moore, J., Ramger, B., & Clewley, D. J. (2022) · Implementation Science Communications · doi:10.1186/s43058-022-00305-2 · Cited by 26 · see citing works
DIAGNOSTIC IMAGING IN A DIRECT-ACCESS SPORTS PHYSICAL THERAPY CLINIC: A 2-YEAR RETROSPECTIVE PRACTICE ANALYSIS.
Crowell, M. S., Dedekam, E., Johnson, M. R., Dembowski, S. C., Westrick, R. B., & Goss, D. L. (2016) · PubMed Central · Cited by 26 · see citing works
Time Between an Emergency Department Visit and Initiation of Physical Therapist Intervention: Health Care Utilization and Costs
Magel, J. S., Kim, J., Fritz, J. M., & Freburger, J. K. (2020) · Physical Therapy · doi:10.1093/ptj/pzaa100 · Cited by 25 · see citing works
Physical Therapists’ Role in Solving the Opioid Epidemic
Mintken, P. E., Moore, J. R., & Flynn, T. W. (2018) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2018.0606 · Cited by 25 · see citing works
Large variability found in musculoskeletal physiotherapy scope of practice throughout WCPT and IFOMPT affiliated countries: An international survey
Froment, F. P., Olson, K. A., Hooper, T. L., Shaffer, S. M., Sizer, P. S., Woodhouse, L. J., & Brismée, J. (2019) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2019.04.012 · Cited by 24 · see citing works
Factors Impacting Physical Therapy Utilization for Patients With Nonspecific Low Back Pain: Retrospective Analysis of a Clinical Data Set
Dolot, J., Hyland, M., Shi, Q., Kim, H.-Y., Viola, D., & Hoekstra, C. (2020) · Physical Therapy · doi:10.1093/ptj/pzaa082 · Cited by 24 · see citing works
Impact of Out-of-Pocket Expenditure on Physical Therapy Utilization for Nonspecific Low Back Pain: Secondary Analysis of the Medical Expenditure Panel Survey Data
Dolot, J., Viola, D., Shi, Q., & Hyland, M. (2015) · Physical Therapy · doi:10.2522/ptj.20150028 · Cited by 23 · see citing works
Associations Between Physical Therapy Continuity of Care and Health Care Utilization and Costs in Patients With Low Back Pain: A Retrospective Cohort Study
Magel, J. S., Kim, J., Thackeray, A., Hawley, C. W., Petersen, S., & Fritz, J. M. (2018) · Physical Therapy · doi:10.1093/ptj/pzy103 · Cited by 23 · see citing works
Impact of Health Information Exchange Adoption on Referral Patterns
Eftekhari, S., Yaraghi, N., Gopal, R. D., & Ramesh, R. (2022) · Management Science · doi:10.1287/mnsc.2022.4435 · Cited by 22 · see citing works
Racial and Ethnic Differences in Receipt of Nonpharmacologic Care for Chronic Low Back Pain Among Medicare Beneficiaries With OUD
Bhondoekhan, F., Marshall, B. D. L., Shireman, T. I., Trivedi, A. N., Merlin, J. S., & Moyo, P. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.33251 · Cited by 22 · see citing works
The association between the supply of select nonpharmacologic providers for pain and use of nonpharmacologic pain management services and initial opioid prescribing patterns for Medicare beneficiaries with persistent musculoskeletal pain
Karmali, R. N., Skinner, A. C., Trogdon, J. G., Weinberger, M., George, S. Z., & Lich, K. H. (2020) · Health Services Research · doi:10.1111/1475-6773.13561 · Cited by 22 · see citing works
Risk Factors for Low Back Pain and Spine Surgery
Kardouni, J. R., Shing, T. L., & Rhon, D. I. (2016) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2016.06.005 · Cited by 21 · see citing works
Effectiveness of a multidisciplinary rehabilitation program in real-world patients with chronic back pain: A pilot cohort data analysis
You, D. S., Ziadni, M. S., Cooley, C. E., Talavera, D. C., Mackey, S. C., & Poupore-King, H. (2021) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.3233/bmr-200305 · Cited by 19 · see citing works
“Studies have noted that ACT [36,37] and PT [38] reduce pain behaviors such as less sick leave and medical visits whereas CBT prevents from taking more sick leave and medical visits in the future [39].”
Background
The Influence of a Guideline-Concordant Stepped Care Approach on Downstream Health Care Utilization in Patients with Spine and Shoulder Pain
Rhon, D. I., Greenlee, T. A., & Fritz, J. M. (2018) · Pain Medicine · doi:10.1093/pm/pny212 · Cited by 20 · see citing works
Comparison of Downstream Health Care Utilization, Costs, and Long‐Term Opioid Use: Physical Therapist Management Versus Opioid Therapy Management After Arthroscopic Hip Surgery
Rhon, D., Snodgrass, S., Cleland, J., Greenlee, T. A., Sissel, C. D., & Cook, C. (2018) · Physical Therapy · doi:10.1093/ptj/pzy019 · Cited by 18 · see citing works
Relationships between physical therapy intervention and opioid use: A scoping review
Brown, L., Beckner, A., Scaff, K. E., Fritz, J. M., Buys, M. J., Patel, S. A., Bayless, K., & Brooke, B. S. (2021) · PM&R · doi:10.1002/pmrj.12654 · Cited by 19 · see citing works
Implementing a new physiotherapist-led primary care model for low back pain: a qualitative study of patient and primary care team perspectives
Vader, K., Donnelly, C. A., French, S. D., Grady, C. M., Hill, J. C., Tripp, D. A., Williams, A., & Miller, J. (2022) · BMC Family Practice · doi:10.1186/s12875-022-01817-5 · Cited by 19 · see citing works
“Although previous research has evaluated models of care that include a primary care visit followed by early referral to a physiotherapist [22, 23], there is a dearth of research on models of care where a physiotherapist is integrated directly within the primary care team for patients with an unmet need for treatment,…”
Method
Implications of Practice Setting on Clinical Outcomes and Efficiency of Care in the Delivery of Physical Therapy Services
Childs, J. D., Harman, J. S., Rodeghero, J. R., Horn, M. E., & George, S. Z. (2014) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2014.5224 · Cited by 19 · see citing works
Evidence-Based Practice Implementation: Case Report of the Evolution of a Quality Improvement Program in a Multicenter Physical Therapy Organization
Stevans, J., Bise, C., McGee, J., Miller, D. L., Rockar, P., & Delitto, A. (2015) · Physical Therapy · doi:10.2522/ptj.20130541 · Cited by 17 · see citing works
Physical Therapists' Level of McKenzie Education, Functional Outcomes, and Utilization in Patients With Low Back Pain
Deutscher, D., Werneke, M. W., Gottlieb, D., Fritz, J. M., & Resnik, L. J. (2014) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2014.5272 · Cited by 19 · see citing works
Changes in Pain Catastrophizing and Fear-Avoidance Beliefs as Mediators of Early Physical Therapy on Disability and Pain in Acute Low-Back Pain: A Secondary Analysis of a Clinical Trial
Sisco-Taylor, B. L., Magel, J. S., McFadden, M., Greene, T., Shen, J., & Fritz, J. M. (2021) · Pain Medicine · doi:10.1093/pm/pnab292 · Cited by 17 · see citing works
Hospital-Based Outpatient Direct Access to Physical Therapist Services: Current Status in Wisconsin
Boissonnault, W. G., & Lovely, K. (2016) · Physical Therapy · doi:10.2522/ptj.20150540 · Cited by 17 · see citing works
Application of a Value Model for the Prevention and Management of Chronic Musculoskeletal Pain by Physical Therapists.
Lentz, T. A., Harman, J. S., Marlow, N. M., & George, S. Z. (2017) · PubMed · doi:10.2522/ptj.20160167 · Cited by 17 · see citing works
Implementation of a Quality Improvement Process Aimed to Deliver Higher-Value Physical Therapy for Patients With Low Back Pain: Case Report
Karlen, E. K., & McCathie, B. (2015) · Physical Therapy · doi:10.2522/ptj.20150035 · Cited by 17 · see citing works
Impact of a value-based insurance design for physical therapy to treat back pain on care utilization and cost
Maeng, D. D., Graboski, A., Allison, P. L., Fisher, D. Y., & Bulger, J. B. (2017) · Journal of Pain Research · doi:10.2147/jpr.s135813 · Cited by 17 · see citing works
“The PT bundle therefore represents an innovative application of the principles of VBID focusing on enhanced access to a potentially high-value but underutilized treatment option to treat a condition that is prone to unnecessary and avoidable care.(20,21) The aim of this study is to demonstrate, using real-world data,…”
A call to action: direct access to physical therapy is highly successful in the US military. When will professional bodies, legislatures, and payors provide the same advantages to all US civilian physical therapists?
Clark, B., Clark, L., Showalter, C. R., & Stoner, T. (2022) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2022.2099893 · Cited by 17 · see citing works
Advanced practice physiotherapy care in emergency departments for patients with musculoskeletal disorders: a pragmatic cluster randomized controlled trial and cost analysis
Matifat, E., Pelletier, E. B., Brison, R., Hébert, L. J., Roy, J., Woodhouse, L. J., Berthelot, S., Daoust, R., Sirois, M., Booth, R., et al. (2023) · Trials · doi:10.1186/s13063-023-07100-x · Cited by 16 · see citing works
Pain pattern classification and directional preference are associated with clinical outcomes for patients with low back pain
Yarznbowicz, R., Tao, M., Owens, A., Wlodarski, M., & Dolutan, J. (2017) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2017.1343538 · Cited by 15 · see citing works
“Health care stakeholders are seeking economic solutions [4].”
Background
Today’s referral is tomorrow’s repeat patient: referrals to and between medical outpatient clinics in a hospital
Safi, M., Clay‐Williams, R., Thude, B. R., Vaisman, J., & Brandt, F. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-07633-y · Cited by 15 · see citing works
“An inefficient referral process can be associated with over testing and repetitive testing [10–12], delayed treatment [13, 14], patient confusion regarding navigation of patient pathways [10, 14], ineffective use of physician and hospital services [11, 15], and impaired patient outcomes [10, 11].”
Background
Low back pain care pathways and costs: association with the type of initial contact health care provider. A retrospective cohort studyPreprint
Elton, D., Kosloff, T. M., Zhang, M., Advani, P., Guo, Y., Shimotsu, S. T., Sy, S., & Feuer, A. (2022) · medRxiv · doi:10.1101/2022.06.17.22276443 · Cited by 15 · see citing works
“Initial contact with a DC has been shown to be associated with lower cost than most HCPs, while early access to physical therapy has had mixed total episode cost outcomes [25,27,45,46].”
BackgroundMethodInfluential
Musculoskeletal Imaging for Low Back Pain in Direct Access Physical Therapy Compared to Primary Care: An Observational Study
Crowell, M. S., Mason, J. S., & McGinniss, J. H. (2022) · International Journal of Sports Physical Therapy · doi:10.26603/001c.31720 · Cited by 14 · see citing works
The perception of physical therapy leaders in Saudi Arabia regarding physical therapy scope of practice in primary health care
Al-Abbad, H., & Al-Haidary, H. M. (2016) · Journal of Physical Therapy Science · doi:10.1589/jpts.28.112 · Cited by 14 · see citing works
Cross-cultural adaptation, reliability and validity of the Turkish version of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire
Günaydın, G., Kanık, Z. H., Karabıçak, G. Ö., Sözlü, U., Pala, Ö. O., Alkan, Z. B., Başar, S., & Çıtaker, S. (2016) · Journal of Orthopaedic Science · doi:10.1016/j.jos.2016.01.006 · Cited by 14 · see citing works
“Low back pain is amongst the most common musculoskeletal disorders [1] and it is quite cumbersome for both individuals and the healthcare system [2,3].”
Background
Navigating the Intersection Between Persistent Pain and the Opioid Crisis: Population Health Perspectives for Physical Therapy
Davenport, T. E., DeVoght, A., Sisneros, H., & Bezruchka, S. (2020) · Physical Therapy · doi:10.1093/ptj/pzaa031 · Cited by 14 · see citing works
Alternative payment models and physician treatment decisions: Evidence from lower back pain
Ding, Y. C., & Liu, C. (2021) · Journal of Health Economics · doi:10.1016/j.jhealeco.2021.102548 · Cited by 14 · see citing works
Associations Between Early Chiropractic Care and Physical Therapy on Subsequent Opioid Use Among Persons With Low Back Pain in Arkansas
Acharya, M., Chopra, D., Smith, A. M., Fritz, J. M., & Martin, B. C. (2022) · Journal of Chiropractic Medicine · doi:10.1016/j.jcm.2022.02.007 · Cited by 13 · see citing works
Utilization and Payments of Office-Based Physical Rehabilitation Services Among Individuals With Commercial Insurance in New York State
Liu, X., Hanney, W. J., Masaracchio, M. F., & Kolber, M. J. (2015) · Physical Therapy · doi:10.2522/ptj.20150060 · Cited by 13 · see citing works
Second opinion in spine surgery: a Brazilian perspective
VIALLE, E. N. (2015) · European Journal of Orthopaedic Surgery & Traumatology · doi:10.1007/s00590-015-1640-3 · Cited by 13 · see citing works
Delayed timing of physical therapy initiation increases the risk of future opioid use in individuals with knee osteoarthritis: a real-world cohort study
Kumar, D., Neogi, T., Peloquin, C. E., Marinko, L. N., Camarinos, J., Aoyagi, K., Felson, D. T., & Dubreuil, M. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2022-106044 · Cited by 12 · see citing works
Physical Therapy for Low Back Pain: What Is It, and When Do We Offer It to Patients?
Carey, T. S., & Freburger, J. K. (2014) · The Annals of Family Medicine · doi:10.1370/afm.1636 · Cited by 12 · see citing works
Physical Therapy and Hospitalization Among Medicare Beneficiaries With Low Back Pain
de Heer, H. ‘., & Warren, M. (2016) · Spine · doi:10.1097/brs.0000000000001571 · Cited by 11 · see citing works
“The finding that PT services were associated with reduced relative risk of hospitalization adds to the body of literature demonstrating that PT utilization among patients with LBP may be associated with reductions in future care utilization and cost.(5,7,8,15,16) For example, Gellhorn et al.”
Result
Comparison of usual podiatric care and early physical therapy intervention for plantar heel pain: study protocol for a parallel-group randomized clinical trial
McClinton, S. M., Flynn, T. W., Heiderscheit, B. C., McPoil, T. G., Pinto, D., Duffy, P. A., & Bennett, J. D. (2013) · Trials · doi:10.1186/1745-6215-14-414 · Cited by 11 · see citing works
“Early physical therapy intervention versus a delayed referral has demonstrated improved outcomes, decreased likelihood of surgery and injections, fewer office visits, and reduced advanced imaging and medication in individuals with low back pain [27-29].”
Background
Impact of interprofessional embedding of physical therapy in a primary care training clinic
McKay, S. E., Buono, F. D., Walker, J. D., Glinski, C. J. M., Printz, D. M. B., & Brienza, R. S. (2020) · Journal of Interprofessional Care · doi:10.1080/13561820.2020.1798898 · Cited by 10 · see citing works
“All of these accomplishments can improve patient satisfaction and pain management (Desmeules et al., 2012; Fritz et al., 2012; Murphy et al., 2005; Ojha et al., 2016).”
Background
Are Exercise and Physical Therapy Common Forms of Conservative Management in the Year Before Lumbar Spine Surgery?
Carrignan, J. A., Simmet, R. T., Coddington, M., Gill, N. W., Greenlee, T. A., McCafferty, R. R., & Rhon, D. I. (2020) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2020.04.006 · Cited by 10 · see citing works
Experiences of Nonpharmacologic Providers Implementing the Oregon Back Pain Policy Expanding Services for Medicaid Recipients: A Focus Group Study
Gray, M. T., LaForge, K., Livingston, C. J., Leichtling, G. J., & Choo, E. K. (2021) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2021.0099 · Cited by 10 · see citing works
“29,30 Recent studies suggest that removal of the referral requirement for physical therapy among back pain patients is associated with reduced medical costs, 31 decrease in medications prescribed, same or better discharge outcomes, and increased patient satisfaction.”
Wearable assistive device for physical load reduction of caregiver - adaptive to caregiver's motion during transferring support
Hasegawa, Y., Hoshino, T., & Tsukahara, A. (2016) · World Automation Congress (WAC) · doi:10.1109/wac.2016.7582975 · Cited by 10 · see citing works

Initial Management Decisions After a New Consultation for Low Back Pain: Implications of the Usage of Physical Therapy for Subsequent Health Care Costs and Utilization
Fritz, J. M., Brennan, G. P., Hunter, S. J., & Magel, J. S. (2013) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2013.01.008 · Cited by 90 · see citing works
Implications of early and guideline adherent physical therapy for low back pain on utilization and costs
Childs, J. D., Fritz, J. M., Wu, S. S., Flynn, T. W., Wainner, R. S., Robertson, E. K., Kim, F. S., & George, S. Z. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-0830-3 · Cited by 290 · see citing works
Initial presentation for acute low back pain: is early physical therapy associated with healthcare utilization and spending? A retrospective review of a National Database
Marrache, M., Prasad, N., Margalit, A., Nayar, S. K., Best, M. J., Fritz, J. M., & Skolasky, R. L. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08255-0 · Cited by 30 · see citing works
Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs
Liu, X., Hanney, W. J., Masaracchio, M. F., Kolber, M. J., Zhao, M., Spaulding, A., & Gabriel, M. H. (2018) · Physical Therapy · doi:10.1093/ptj/pzy023 · Cited by 72 · see citing works
IMPACT OF TIMING OF PHYSICAL THERAPY ON HEALTH CARE UTILIZATION AND COSTS AMONG PATIENTS WITH ACUTE LOW BACK PAIN: EVIDENCE FROM NEW YORK STATE
Liu, X., Hanney, W. J., & Masaracchio, M. F. (2016) · Value in Health · doi:10.1016/j.jval.2016.03.1118

Authors: Fritz, J. M., Childs, J. D., Wainner, R. S., & Flynn, T. W.
Affiliations: Intermountain Healthcare (US)
Baylor University (US)
Texas State University (US)
Rocky Mountain University of Health Professions (US)
Corresponding author: Fritz, Julie M.
ORCID: Fritz, Julie M.
Flynn, Timothy W.
Venue: Spine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2012-12
Volume: 37
Issue: 25
Pages: 2114-2121
ISSN: 0362-2436 (ISSN-L)
DOI: 10.1097/brs.0b013e31825d32f5
OpenAlex: W2014638499
Cited by: 259
References: 47
Citations by year: 2026: 13 · 2025: 26 · 2024: 24 · 2023: 21 · 2022: 29 · 2021: 17 · 2020: 26 · 2019: 17 · 2018: 24 · 2017: 13 · 2016: 18 · 2015: 13 · 2014: 12 · 2013: 5 · 2012: 1
FWCI: 7.23
Type: journal article
Language: en
Open access: closed
Locations: Spine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords: low back pain, physiotherapy referral, primary care, guideline adherence, health care utilization, health care costs, opioid use, imaging utilization, spinal surgery, employer-sponsored health insurance
MeSH terms: Analgesics, Opioid, Diagnostic Imaging, Health Services, Humans, Office Visits, Practice Patterns, Physicians', Primary Health Care, Referral and Consultation, Retrospective Studies, Time Factors, Multivariate Analysis, Linear Models, Logistic Models, Odds Ratio, Drug Costs, Treatment Outcome, Cost Savings, Health Care Costs, Low Back Pain, Orthopedic Procedures, Physical Therapy Modalities, Early Medical Intervention

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Primary Care Referral of Patients With Low Back Pain to Physical Therapy: Impact on Future Health Care Utilization and Costs

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