Thackeray A, et al. - Here, the physicians investigated differences among newly consulting patients with low back pain (LBP) who received a physical therapy (PT) referral and those who did not. Furthermore, they aimed to explore differences between patients who participated in PT to those who did not and to compare the effect of a PT referral and PT participation on LBP-related health care utilization and costs over 1 year. The index provider’s prescription and imaging decisions and patient demographics were correlated with PT referrals and participation among Medicaid recipients with new-onset LBP. During follow-up, a referral to PT and subsequent PT participation was correlated with reduced opioid prescriptions. No difference was found in overall LBP-related health care costs.

Methods

• Using electronic medical records and claims data, the physicians performed this retrospective cohort study.
• They included 454 Medicaid enrollees with new LBP consultations (mean age, 40.4 years; SD = 12.0; 70% women) for this study.
• Advanced imaging, injections, emergency department visits, opioid prescriptions, surgery and LBP-related costs were included as outcomes.
• They used multivariate models to assess variables associated with a PT consult, PT participation, and subsequent outcomes.

Results

• Within 7 days of the index LBP visit, 251 (55%) participants received a PT consult and 81 (19%) participated in PT.
• If patients were prescribed non-steroidal anti-inflammatories (aOR = 1.81; 95% confidence interval [CI], 1.0 to 3.27; P=.05) or muscle relaxers (adjusted odds ratio [aOR] = 2.24; 95% CI, 1.03 to 4.87; P=.04), the odds of a PT consult were increased.
• While tobacco users and individual with multiple comorbidities were less likely to receive a PT consult (aOR = 0.52; 95% CI, 0.20 to 0.91) and 0.42 (95% CI, 0.23 to 0.78), respectively).
• Higher odds of participating in PT were found for patients receiving an radiograph at baseline (odds ratio [OR] = 2.63; 95% CI, 1.25 to 5.53) or having multiple comorbidities (OR = 2.96; 95% CI, 1.20 to 7.20).
• Reduced odds of receiving an opioid prescription over the year following the index visit were determined with a PT consult (aOR = 0.65; 95% CI, 0.43 to 1.00) and with PT participation (aOR = 0.47; 95% CI, 0.24 to 0.92).
• Between any of the groups, no differences were noted in LBP related costs over 1 year.