title: Physical therapy for chronic low back pain in North Carolina: overuse, underuse, or misuse?
abstract: BACKGROUND
  There are limited population-based studies of determinants of physical therapy use for chronic low back pain (LBP) and of the types of treatments received by individuals who see a physical therapist.
  
  
  OBJECTIVE
  The purposes of this study were: (1) to identify determinants of physical therapy use for chronic LBP, (2) to describe physical therapy treatments for chronic LBP, and (3) to compare use of treatments with current best evidence on care for this condition.
  
  
  METHODS
  This study was a cross-sectional, population-based telephone survey of North Carolinians.
  
  
  METHODS
  Five hundred eighty-eight individuals with chronic LBP who had sought care in the previous year were surveyed on their health and health care use. Bivariate and multivariable analyses were conducted to identify predisposing, enabling, and need characteristics associated with physical therapy use. Descriptive analyses were conducted to determine the use of physical treatments for individuals who saw a physical therapist. Use of treatments was compared with evidence from systematic reviews.
  
  
  RESULTS
  Of our sample, 29.7% had seen a physical therapist in the previous year, with a mean of 15.6 visits. In multivariable analyses, receiving workers' compensation, seeing physician specialists, and higher Medical Outcomes Study 12-Item Short-Form Health Survey questionnaire (SF-12) physical component scores were positively associated with physical therapy use. Having no health insurance was negatively associated with physical therapy use. Exercise was the most frequent treatment received (75% of sample), and traction was the least frequent treatment received (7%). Some effective treatments were underutilized, whereas some ineffective treatments were overutilized.
  
  
  CONCLUSIONS
  Only one state was examined, and findings were based on patient report.
  
  
  CONCLUSIONS
  Fewer than one third of individuals with chronic LBP saw a physical therapist. Health-related and non-health-related factors were associated with physical therapy use. Individuals who saw a physical therapist did not always receive evidence-based treatments. There are potential opportunities for improving access to and quality of physical therapy for chronic LBP.
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA. janet_freburger@unc.edu
authors.forename: Janet K
authors.initials: JK
authors.lastname: Freburger
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Carey
authors.forename: George M
authors.initials: GM
authors.lastname: Holmes
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D006297:Health Services Accessibility; D006300:Health Services Misuse / Q000191:economics / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation*; D017057:Medically Uninsured; D008875:Middle Aged; D015999:Multivariate Analysis; D009657:North Carolina; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D014143:Traction / Q000706:statistics & numerical data; D055815:Young Adult