title: Subsequent health-care utilization associated with early physical therapy for new episodes of low back pain in older adults.
abstract: The association between early physical therapy (PT) and subsequent health-care utilization following a new visit for low back pain is not clear, particularly in the setting of acute low back pain.
  
  
  
  This study aimed to estimate the association between initiating early PT following a new visit for an episode of low back pain and subsequent back pain-specific health-care utilization in older adults.
  
  
  
  This is a prospective cohort study. Data were collected at three integrated health-care systems in the United States through the Back Pain Outcomes using Longitudinal Data (BOLD) registry.
  
  
  
  We recruited 4,723 adults, aged 65 and older, presenting to a primary care setting with a new episode of low back pain.
  
  
  
  Primary outcome was total back pain-specific relative value units (RVUs), from days 29 to 365. Secondary outcomes included overall RVUs for all health care and use of specific health-care services including imaging (x-ray and magnetic resonance imaging [MRI] or computed tomography [CT]), emergency department visits, physician visits, PT, spinal injections, spinal surgeries, and opioid use.
  
  
  
  We compared patients who had early PT (initiated within 28 days of the index visit) with those not initiating early PT using appropriate, generalized linear models to adjust for potential confounding variables.
  
  
  
  Adjusted analysis found no statistically significant difference in total spine RVUs between the two groups (ratio of means 1.19, 95% CI of 0.72-1.96, p=.49). For secondary outcomes, only the difference between total spine imaging RVUs and total PT RVUs was statistically significant. The early PT group had greater PT RVUs; the ratio of means was 2.56 (95% CI of 2.17-3.03, p<.001). The early PT group had greater imaging RVUs; the ratio of means was 1.37 (95% CI of 1.09-1.71, p=.01.) CONCLUSIONS: We found that in a group of older adults presenting for a new episode of low back pain, the use of early PT is not associated with any statistically significant difference in subsequent back pain-specific health-care utilization compared with patients not receiving early PT.
authors.affiliation: Rebound Orthopedics and Neurosurgery 200 NE Mother Joseph Place Suite 210 Vancouver, WA, 98664. Electronic address: dkarvelas@reboundmd.com.
authors.forename: Deven A
authors.initials: DA
authors.lastname: Karvelas
authors.affiliation: Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave. NE Box 359455, 14th Floor Seattle, WA 98105.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Rundell
authors.affiliation: Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave. NE Box 359455, 14th Floor Seattle, WA 98105.
authors.forename: Janna L
authors.initials: JL
authors.lastname: Friedly
authors.affiliation: Department of Rehabilitation and Regenerative Medicine, Weill Cornell Medical Center, 525 East 68th St., 16th Floor New York, NY 10065.
authors.forename: Alfred C
authors.initials: AC
authors.lastname: Gellhorn
authors.affiliation: Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave. NE Box 359455, 14th Floor Seattle, WA 98105.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Gold
authors.affiliation: Center for Biomedical Statistics, University of Washington, Box 357232 Seattle, WA 98195.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Comstock
authors.affiliation: Center for Biomedical Statistics, University of Washington, Box 357232 Seattle, WA 98195.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Heagerty
authors.affiliation: Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave. NE Box 359455, 14th Floor Seattle, WA 98105.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Bresnahan
authors.affiliation: Neuroscience Institute, Henry Ford Hospital, 2799 West Grand Blvd Detroit, MI 48202.
authors.forename: David R
authors.initials: DR
authors.lastname: Nerenz
authors.affiliation: Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave. NE Box 359455, 14th Floor Seattle, WA 98105.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Jarvik
mesh_terms: D000368:Aged; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D026741:Physical Therapy Modalities; D011320:Primary Health Care; D011446:Prospective Studies; D013997:Time Factors; D014481:United States
keywords: Acute low back pain; Cost; Early physical therapy; Health-care utilization; Low back pain; Older adults; Physical therapy