A recently published study of patients with new low back pain (LBP) who received referral from a primary care provider concludes that not only is physical therapy a less expensive next step than advanced imaging, it's an approach that results in lower utilization costs over time.
Researchers Julie M. Fritz, PT, PhD, FAPTA, Gerard P. Brennan, PT, PhD, and Stephen J. Hunter, PT, PhD, OCS, analyzed utilization records and other health information for 841 individuals who consulted with a primary provider about uncomplicated LBP and were referred for management outside primary care within 6 weeks. Of those individuals, 385 received advanced imagining and 377 received physical therapy (the remaining 79 patients received a physician specialist visit or "other care," including chiropractic). The study focused on records obtained from 21 different providers around Salt Lake City, Utah, between 2004 and 2010.
What they found was that across the board, physical therapy was the less costly approach. Initial referral for physical therapy cost $504 on average (for an average 3.8 visits), compared with an average of $1,306 for magnetic resonance imaging (the technology used in "almost all" of the imaging, according to authors).
Even more dramatically, average subsequent costs over the next year were over 66% lower for the patients who began with a physical therapy referral--$1,871, compared with $6,664 charged to the imaging group over the same time period. Those differences remained largely in place even when researchers matched individuals for covariates including prior surgery, use of medication, osteoporosis, and mental health issues. Results of the study appear in the journal Health Services Research (abstract only available for free).
Authors found that patients who receive imaging as a first referral often follow a different path than those who receive physical therapy, writing that referral to imaging "increased the odds of surgery, injections, specialist, and emergency department visits within a year."
Researchers attribute some of the variation to perceptions around imaging. "Advanced imaging often 'labels' a patient's LBP that might otherwise be viewed as nonspecific and uncomplicated, causing heightened concern in some patients and providers and motivating additional care-seeking," they write.
On the other hand, they write, "physical therapy may avoid the negative consequences of a labeling effect from imaging" by "provid[ing] patients with an active approach to LBP, enhancing patients' perceived ability to self-manage their condition."
"This is important research, because it provides even more evidence that physical therapy is a less costly alternative to medication, surgery, and other invasive medical procedures," said Nancy White, PT, DPT, APTA executive vice president of professional affairs. "Not only do patients benefit from the improved outcomes resulting from an active approach to care, society benefits from the reduced financial burden on our health care system. The cost savings Fritz and her colleagues describe here are significant enough to be recognized by health policy makers, payers, and other health professionals."
Authors acknowledge that their study was limited to newly reported and uncomplicated LBP, and that patient-centered function or satisfaction outcomes were not recorded. Still, they write, for individuals with this type of LBP who have expectations for additional care beyond a primary provider, "physical therapy may be the preferred initial step instead of advanced imaging."