Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain

Abstract Objective The aim of this study was to examine the association between the length of time between an emergency department (ED) visit and the subsequent initiation of physical therapist intervention for low back pain (LBP) on 1-year LBP-related health care utilization (ie, surgery, advanced imaging, injections, long-term opioid use, ED visits) and costs. Methods This retrospective cohort study focused on individuals who consulted the ED for an initial visit for LBP. Claims from a single statewide, all-payers database were used. LBP-related health care use and costs for the 12 months after the ED visit were extracted. Poisson and general linear models weighted with inverse probability treatment weights were used to compare the outcomes of patients who attended physical therapy early or delayed after the ED visit. Results Compared with the delayed physical therapy group (n = 94), the early physical therapy group (n = 171) had a lower risk of receiving lumbar surgery (relative risk [RR] = 0.47, 95% CI = 0.26–0.86) and advanced imaging (RR = 0.72, 95% CI = 0.55–0.95), and they were less likely to have long-term opioid use (RR = 0.45, 95% CI = 0.28–0.76). The early physical therapy group incurred lower costs (mean = $3,806, 95% CI = $1,998–$4,184) than those in the delayed physical therapy group (mean = $8,689, 95% CI = $4,653–$12,727). Conclusion Early physical therapy following an ED visit was associated with a reduced risk of using some types of health care and reduced health care costs in the 12 months following the ED visit. Impact Statement The ED is an entry point into the health care system for patients with LBP. Until now, the impact of the length of time between an ED visit and physical therapy for LBP has not been well understood. This study shows that swift initiation of physical therapy following an ED visit for LBP is associated with lower LBP-related health utilization for some important outcomes and lower LBP-related health care costs.

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Value-Based Care for Musculoskeletal Pain: Are Physical Therapists Ready to Deliver?

Physical Therapy ◽

10.1093/ptj/pzz171 ◽

2019 ◽

Vol 100 (4) ◽

pp. 621-632 ◽

Cited By ~ 1

Author(s):

Trevor A Lentz ◽

Adam P Goode ◽

Charles A Thigpen ◽

Steven Z George

Keyword(s):

Health Care ◽

Physical Therapy ◽

Musculoskeletal Pain ◽

Clinical Decision Making ◽

Physical Therapists ◽

Physical Therapist ◽

Great Promise ◽

Health Care Environment ◽

Early Physical Therapy ◽

Analytical Approaches

Abstract Early physical therapy models hold great promise for delivering high-value care for individuals with musculoskeletal pain. However, existing physical therapist practice and research standards are misaligned with value-based principles, which limits the potential for growth and sustainability of these models. This Perspective describes how the value proposition of early physical therapy can be improved by redefining harm, embracing a prognostic approach to clinical decision making, and advocating for system-wide guideline-adherent pain care. It also outlines the need to adopt a common language to describe these models and embrace new, rigorous study designs and analytical approaches to better understand where and how early physical therapy delivers value. The goal is to define a clear path forward to ensure physical therapists are aligned within health care systems to deliver on the American Physical Therapy Association’s vision of high-value care in a rapidly changing health care environment.

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Re: Early Physical Therapy for Acute Low Back Pain May Not Reduce Health Services Utilization, Costs, and Opioid Use

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2019.03.003 ◽

2019 ◽

Vol 100 (7) ◽

pp. 1376-1377

Author(s):

Elizabeth Arnold ◽

Adam Goode ◽

Derek Clewley

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Health Services ◽

Health Services Utilization ◽

Low Back ◽

Opioid Use ◽

Services Utilization ◽

Acute Low Back Pain ◽

Early Physical Therapy

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Does early physical therapy intervention reduce opioid burden and improve functionality in the management of chronic lower back pain?

Mental Health Clinician ◽

10.9740/mhc.2020.07.215 ◽

2020 ◽

Vol 10 (4) ◽

pp. 215-221

Author(s):

Shedrick Martin ◽

Kimberly Tallian ◽

Victoria T. Nguyen ◽

Jason van Dyke ◽

Harminder Sikand

Keyword(s):

Back Pain ◽

Physical Therapy ◽

Lower Back Pain ◽

Medication Use ◽

Chronic Lower Back Pain ◽

Opioid Use ◽

Pain Scores ◽

Lower Back ◽

Early Physical Therapy ◽

The Impact

Abstract Introduction Chronic lower back pain is a leading cause of disability in US adults. Opioid use continues to be controversial despite the Centers for Disease Control and Prevention guidance on chronic pain management to use nonpharmacologic and nonopioid pharmacologic interventions. The objectives of the study were to assess the impact of early physical therapy (PT) intervention on improving functionality and reducing opioid burden in patients with chronic lower back pain. Methods A single-center, retrospective chart review of patients receiving ≥6 PT visits and treated with either opioids first (OF) or PT first (PTF) therapy for chronic lower back pain were evaluated. Concomitant use of nonopioid and nonpharmacologic therapy was permitted. The Oswestry Disability Index (ODI), a survey measuring functionality, was recorded for PTF group. Pain scores and medication use including opioids were collected at treatment initiation and completion. Results One hundred and eighty patients were included in three groups: OF group (n = 60), PTF group (n = 60), and PTF + ODI group (n = 60). The PTF + ODI group had mean ODI reduction of 11.9% (P < .001). More OF patients were lost to follow up (68.3%) or failed PT (60%) compared to the PTF group, 38.3% and 3.3% (P < .001). Reduction in both opioid and nonopioid medications as well as pain scores were observed but not statistically significant. Discussion Early PT resulted in improved functionality, decreased pain, and reduced medication use upon PT completion. These findings suggest PT, along with nonopioid modalities, are a viable first-line option for the management of chronic lower back pain.

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