Treatment adherence
Does early, guideline-true physical therapy cut back-pain costs?
Open access · cc by · source: Europe PMC
Among 753,450 MHS adults with new LBP, early guideline-adherent PT (17,175 people) tracked less imaging, injections, surgery, and opioids and about 60% lower 2-year LBP-related costs.
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Study at a glance
- Design
- Cohort — Retrospective Military Health System cohort of new primary-care LBP visits (2007–2009) with 2-year utilization/cost follow-up.
- N
- N=753450 · 753,450 unique patients 18–60 after exclusions; 122,723 (16.3%) used PT within 90 days; 17,175 early + guideline-adherent.
- Population
- MHS beneficiaries aged 18–60 with a new primary-care low-back-pain visit (no LBP care in prior 12 months).
- Outcome
- 2-year advanced imaging, lumbar injections, lumbar surgery, opioid use, and LBP-related costs by PT timing and guideline adherence.
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Inspect source passages
Does early, guideline-true physical therapy cut back-pain costs?
These passages occur verbatim in the stored paper text. They support the points listed below; they do not verify every statement in the explanation.
753,450 eligible patients; 16.3% (122,723) used PT; 24.0% of PT users got early adherent care.
753,450 eligible patients with a primary care visit for LBP between 18–60 years of age were considered. Physical therapy was utilized by 16.3% (n = 122,723) of patients, with 24.0% (n = 17,175) of those receiving early physical therapy that was adherent to recommendations for active treatment.
Early PT AORs: imaging 0.52, injections 0.56, surgery 0.59, opioids 0.62.
Patients who received early physical therapy had a decreased likelihood of receiving advanced imaging (AOR = 0.52, 99% CI: 0.50, 0.54), spinal injections (AOR = 0.56, 99% CI: 0.53, 0.59), lumbar spine surgery (AOR = 0.59, 99% CI: 0.54, 0.65), or opioid use (AOR = 0.62, 99% CI: 0.60, 0.64).
Key findings
16.3% used PT. Early vs delayed PT: imaging AOR 0.52, injections 0.56, surgery 0.59, opioids 0.62; LBP costs $1,828 vs $3,031 (about $1,202 lower). Adherent vs non-adherent care also cut imaging/injections/surgery (AORs 0.72–0.85) but not opioids.
Methodology
Identified new primary-care LBP visits 2007–2009, classified PT within 14 days as early (vs 14–90 days delayed), scored PT content as guideline-adherent active care, and compared 2-year utilization (adjusted ORs, 99% CIs) and costs.
Limitations
Observational claims cannot prove PT caused the savings—healthier or more motivated patients may get early adherent PT; RCTs are still needed before policy mandates.
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