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

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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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See all 259

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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Orthopedics and Sports 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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