On March 27, The Washington Post published an article summarizing the findings of research that compared health costs for patients with uncomplicated low back pain (LBP) who were referred to physical therapy with patients referred for advanced imaging. As reported in PT in Motion News, the results showed that physical therapy typically resulted in dramatically lower subsequent costs than a first referral for imaging. The original research article was published in the journal Health Services Research (abstract only available for free).
The Post article characterized the reasons for the differences as being “more likely found in the heads of patients and doctors than in anyone’s back.” Post reporter Lenny Bernstein writes that patients with uncomplicated first-time LBP can “pressure” physicians for a referral, and physicians may comply—sometimes with a referral for advanced imaging, sometimes for a referral to physical therapy.
The lower health care costs associated with physical therapy have a connection with how patients respond to physical therapy’s more proactive, patient-focused approach, according to the Post.
In summarizing comments from Julie M. Fritz, PT, PhD, FAPTA, the study’s lead author, the Post describes physical therapy as an approach that “focuses on educating patients about what might be causing their back pain, assuring them that most problems subside in time, and engaging them in their therapy.”
The study theorizes that as opposed to physical therapy, a referral for imaging early on can lead to a different patient attitude, one that often results in more testing, more physician visits, and greater use of medication. After 1 year, the imaging-first approach can result in average costs over 3 times higher than a physical therapy-first approach, according to the study.
Fritz is quoted in the article saying that “We think this is an area where our profession has something to offer, especially when it’s timed correctly,” adding that advanced imaging can be appropriate thing to do, but “just not early in the course of care for most patients.”
Available at the APTA Learning Center: pre-recorded CE on manipulation for LBP presented by study author Julie M. Fritz, PT, PhD, FAPTA; also “Manual therapy management of the lumbopelvic spine” presented by Josh Cleland, PT, DPT, PhD, OCS, and Shane Koppenhaver, PT, PhD, OCS, FAAOMPT.