Manual therapy provided by physical therapists in a hospital-based setting: a retrospective analysis.
OBJECTIVE
The purpose of this study was to compare outcomes, complications, and hospital disposition in a cohort of patients hospitalized for low back pain who receive physical therapist (PT)-administered manual therapy (mobilization and manipulation) vs those who do not receive manual therapy.


METHODS
The study was a retrospective data collection that used the Nationwide Inpatient Sample. Seventy-five patients hospitalized with low back pain who receive PT-administered manual therapy were matched using specific covariates with patients with low back who did not receive manual therapy. Bivariate analyses and regression modeling were used to determine comparisons between the 2 groups.


RESULTS
Findings indicated that patients who received PT manual therapy had significantly longer lengths of hospital stay (P < .01) and had significantly higher inflation-adjusted costs of care (P < .01). After regression modeling and adjustments for covariates, findings for length of stay were still higher in the PT manual therapy group (P < .01), but costs were significantly lower for this group (P < .01). There were minimal findings of complications.


CONCLUSIONS
Of 106 340 patients admitted for low back pain originally queried, only 75 patients (0.07%) received manual therapy, a markedly small number of patients. Outcomes may be reflective of the low effect size of manual therapy in a hospital setting or the inability to control for referral and hospital care patterns, thus disallowing appropriate matching.
Department of Surgery, Center for Excellence in Surgical Outcomes, Durham, NC, USA. chad.cook@duke.edu
Chad
C
Cook
Amy
A
Cook
Teddy
T
Worrell
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D016014:Linear Models; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D026201:Musculoskeletal Manipulations / Q000379:methods; D010147:Pain Measurement; D010814:Physical Therapy Department, Hospital; D026741:Physical Therapy Modalities; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome