Dr. Mishock: Early referral to physical therapy for low back pain reduces cost and improves outcomes
Low back pain (LBP) is a common and costly medical condition associated with significant physical pain, impaired function, and loss of productivity. LBP is the leading cause of disability in the US exceeding $100 billion per year in treatment, reduced productivity and lost wages. Approximately, 70 million adults have LBP in any given 3 month period of time. (Health Stats, 2015).
Evidence indicates that physical therapy is a costeffective treatment that works to reduce pain and improve function in individuals with LBP. However, only 20% of patients with low back pain are referred to physical therapy by physicians. Instead, many primary care providers opt for; medication, advanced imaging, and rest. (JAMA, 2013) Approximately 29% of physicians prescribe opioids for treatment of low back pain. (JAMA Intern Med, 2013) With the recent opioid epidemic, physical therapy can be an alternative to the highly addictive pain medications used to treat low back pain.
The timing of the physical therapy referral is critical. Early referral to physical therapy can; improve pain and functional outcomes, reduce absenteeism at work, and reduce imaging tests. (Spine, 2015) A recent study used data from employer-sponsored health insurance claims of those who received physical therapy versus those who did not for low back pain. The authors found that patients receiving physical therapy within 3 days of the onset of LBP had the lowest health care utilization and cost. Beyond this, patients recovered faster with less disability. The cost associated with early referrals to physical therapy for low back pain was approximately 50% less expensive than for those not receiving physical therapy at all. It was estimated if low back patients were seen in physical therapy within 3 days of onset it would save US economy >$7.2 billion per year. (Physical therapy, 2018)
Why does physical therapy save cost, decrease pain, and improve function? Physical therapists are doctorate-level trained health care providers who will perform a complete musculoskeletal history and examination to determine the root cause of the low back pain. The physical therapist will assess posture and body mechanics and make recommendations for ergonomic changes at home and work. They will provide hands-on manual therapy treatments (techniques done by physical therapists using their hands in very precise ways to relax muscles in spasm, lengthen tight muscles, improve circulation, and optimize scar tissue development). Physical therapy modalities (the use of cold, heat, electricity, and ultrasound) can be utilized early in the treatment to reduce pain and promote healing. Active exercise and functional retraining programs are instituted early to help prevent fear avoidance of pain, improve optimal tissue healing, and return the patient to the highest level of function. All the while the physical therapist is educating the patient on how to prevent future episodes of low back pain through home exercise programs and patient education on body mechanics and posture.
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