title: Patient-reported outcomes associated with use of physical therapist services by older adults with a new visit for back pain.
abstract: BACKGROUND
  Among older adults, it is not clear how different types or amounts of physical therapy may be associated with improvements in back pain and function.
  
  
  OBJECTIVE
  The study objective was to investigate the association between types or amounts of physical therapist services and 1-year outcomes among older adults with back pain.
  
  
  METHODS
  This was a prospective cohort study.
  
  
  METHODS
  A total of 3,771 older adults who were enrolled in a cohort study and who had a new primary care visit for back pain participated. Physical therapy use was ascertained from electronic health records. The following patient-reported outcomes were collected over 12 months: back-related disability (Roland-Morris Disability Questionnaire) and back and leg pain intensity (11-point numerical rating scale). Marginal structural models were used to estimate average effects of different amounts of physical therapy use on disability and pain for all types of physical therapy and for active, passive, and manual physical therapy.
  
  
  RESULTS
  A total of 1,285 participants (34.1%) received some physical therapy. There was no statistically significant gradient in relationships between physical therapy use and back-related disability score. The use of passive or manual therapy was not consistently associated with pain outcomes. Higher amounts of active physical therapy were associated with decreased back and leg pain and increased odds of clinically meaningful improvements in back and leg pain relative to results obtained with no active physical therapy.
  
  
  CONCLUSIONS
  The fact that few participants had high amounts of physical therapy use limited precision and the ability to test for nonlinear relationships for the amount of use.
  
  
  CONCLUSIONS
  Higher amounts of active physical therapy were most consistently related to the greatest improvements in pain intensity; however, as with all observational studies, the results must be interpreted with caution.
authors.affiliation: S.D. Rundell, PT, DPT, PhD, Department of Rehabilitation Medicine and Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington. Mailing address: University of Washington, Box 359455, 4333 Brooklyn Ave NE, Seattle, WA 98105 (USA). srundell@uw.edu.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Rundell
authors.affiliation: K.J. Sherman, PhD, MPH, Department of Epidemiology, University of Washington, and Group Health Research Institute, Seattle, Washington.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Sherman
authors.affiliation: P.J. Heagerty, PhD, Center for Biomedical Statistics, Department of Biostatistics, University of Washington.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Heagerty
authors.affiliation: C. Mock, MD, PhD, MPH, Department of Epidemiology, University of Washington, and Harborview Injury Prevention Research Center, Seattle, Washington.
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
authors.affiliation: J.G. Jarvik, MD, MPH, Comparative Effectiveness, Cost, and Outcomes Research Center and Department of Radiology, Neurological Surgery, Health Services, Orthopedic Surgery and Sports Medicine, and Pharmacy, University of Washington.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Jarvik
mesh_terms: D000368:Aged; D001416:Back Pain / Q000534:rehabilitation*; D004185:Disability Evaluation; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012042:Registries; D014481:United States