title: Physical therapy for acute low back pain: associations with subsequent healthcare costs.
abstract: METHODS
  Case-control.
  
  
  OBJECTIVE
  To examine the association between adherence to the evidence-based recommendation for active physical therapy care and clinical outcomes along with subsequent healthcare utilization and charges for 1 year after completion of physical therapy.
  
  
  BACKGROUND
  Low back pain (LBP) is a common condition associated with high costs. Many patients with acute LBP receive physical therapy. The type of physical therapy care provided may impact subsequent healthcare costs.
  
  
  METHODS
  A retrospective review was undertaken of patients age 18-60 with acute (<90 days) LBP receiving physical therapy covered by 1 insurance provider. Adherence to the recommendation for active care was determined from billing records. Disability (Oswestry) and pain (numerical pain rating) were assessed at the beginning and completion of physical therapy. Subsequent healthcare utilization for LBP and charges were recorded from insurer's databases.
  
  
  RESULTS
  Four hundred and seventy-one patients were included (mean age 41.2 years [SD = 11.0], 54% female), 28.0% received adherent care. Patients receiving adherent care had fewer physical therapy visits (mean difference 1.3 visits, P < 0.05) with lower charges (nontransformed mean difference $167, P < 0.05), greater improvement in pain (mean difference 12.3%, 95% confidence interval [CI]: 3.2-21.3) and disability (mean difference 17.6%, 95% CI: 11.1-24.1). During the year after discharge, receiving adherent care was associated with a lower likelihood of receiving prescription medication (46.2% vs. 57.2%, P < 0.05), magnetic resonance imaging (MRI) (8.3% vs. 15.9%, P < 0.05), or epidural injections (5.3% vs. 12.1%, P < 0.05).
  
  
  CONCLUSIONS
  Adherence to the recommendation for active care was associated with better clinical outcomes and decreased subsequent use of prescription medication, MRI, and injections. Improving adherence to this recommendation may present an opportunity to improve the cost-effectiveness of care for acute LBP.
authors.affiliation: Rehabilitation Agency, Intermountain Healthcare, University of Utah, Salt Lake City, Utah, USA. julie.fritz@hsc.utah.edu
authors.forename: Julie M
authors.initials: JM
authors.lastname: Fritz
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cleland
authors.forename: Matthew
authors.initials: M
authors.lastname: Speckman
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Brennan
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Hunter
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D019983:Guideline Adherence / Q000191:economics / Q000592:standards; D017048:Health Care Costs / Q000592:standards; D006801:Humans; D017116:Low Back Pain / Q000191:economics* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000191:economics* / Q000592:standards; D012189:Retrospective Studies