title: Impact of Out-of-Pocket Expenditure on Physical Therapy Utilization for Nonspecific Low Back Pain: Secondary Analysis of the Medical Expenditure Panel Survey Data.
abstract: BACKGROUND
  Physical therapy decreases low back pain, improves function, and may lead to decreased use of medical services. However, factors predicting physical therapy utilization for patients with low back pain are not well understood.
  
  
  OBJECTIVE
  The purpose of this study was to identify the impact of out-of-pocket expenditure on physical therapy utilization for US adults with nonspecific low back pain.
  
  
  METHODS
  This study was a secondary analysis of retrospective Medical Expenditure Panel Survey data.
  
  
  METHODS
  The participants were US adults with nonspecific low back pain. The outcome variable was the number of visits per episode of care. The research variable was out-of-pocket expenditure. Covariate variables were Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) component scores. Descriptive statistics and multiple linear regression analyses were performed.
  
  
  RESULTS
  Three hundred fourteen adults met the inclusion criteria and submitted SF-12 scores, representing nearly 4 million adults. Out-of-pocket expenditure, physical component score, and the age-insurance category "18-64 years with public coverage only for all of the year or uninsured all of the year" negatively predicted visits per episode of care in the final regression model.
  
  
  CONCLUSIONS
  Limitations of the study included use of a nonexperimental design, lack of information about symptom severity and content of physical therapy, and SF-12 scores were not taken coincidental with the episode of care.
  
  
  CONCLUSIONS
  Out-of-pocket expenditure negatively predicts physical therapy utilization. More research is needed to identify all factors influencing physical therapy utilization so that effective health policies may be developed.
authors.affiliation: J. Dolot, PT, DPT, DrPH, OCS, Department of Physical Therapy, School of Health Sciences and Practice, New York Medical College, 30 Plaza W, Valhalla, NY 10595 (USA). janet_dolot@nymc.edu.
authors.forename: Janet
authors.initials: J
authors.lastname: Dolot
authors.affiliation: D. Viola, PhD, Center for Regional Healthcare Innovation, Westchester Medical Center, Hawthorne, New York.
authors.forename: Deborah
authors.initials: D
authors.lastname: Viola
authors.affiliation: Q. Shi, PhD, Department of Epidemiology and Community Health, School of Health Sciences and Practice, New York Medical College.
authors.forename: Qiuhu
authors.initials: Q
authors.lastname: Shi
authors.affiliation: M. Hyland, PT, PhD, MPA, Rye Physical Therapy & Rehabilitation, Rye, New York.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hyland
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005102:Health Expenditures; D006302:Health Services Research; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D017116:Low Back Pain / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities / Q000191:economics* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States