American researchers recently investigated whether early physical therapy was cost-effective for the treatment of low back pain.
Low back pain is becoming an increasingly important health issue in society, representing the cause behind 2-3% of all adult visits to a physician. As well, medical costs associated with low back pain—estimated at $90 billion in the United States—are rising faster than the overall health care average. However, this increased spending has not produced a benefit to many patients. Indeed, the incidence of poor outcomes or even long-term disability from low back pain treatments continues to increase.
One area inviting investigation is whether early physical therapy will improve these outcomes, as current primary care practices advise low-back-pain patients to be physically active and optimistic while delaying physical therapy in patients until a few weeks after the onset of symptoms. With this in mind, a group of American researchers studied the effect of early physical therapy on a group of patients with low back pain with respect to both outcome and cost.
Immediate Therapy or Delayed Therapy?
The study population was comprised of 220 patients who had visited a primary care provider between March 2011 and November 2013. The eligibility of the population included the following criteria:
- Between 18-60 years of age
- Having a current low back pain episode of less than 16 days duration
- The pain did not radiate (move) below the knee
- No clinical signs of nerve root compression
Of the 220 patients, 108 were given early physical therapy, while the remaining 112 were given the regular treatment regimen emphasizing physical activity. The physical therapy group received four sessions of physical therapy over four weeks once the study began, while the “usual care” group waited four weeks before being given the option of physical therapy treatment. The patients all filled out self-reports at the onset of the study (baseline), and after four weeks, three months, and one year.
To determine cost-effectiveness, the authors calculated both total costs and quality-adjusted life years (QALYs). Total costs comprised both direct (e.g. physical therapy, medication) and indirect costs (i.e., costs due to lost work and lost productivity). The factors used to calculate QALY was based on scoring of the following five factors: mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. The results were recently published in the journal Spine.
Early Physical Therapy More Effective and Cost-Effective
The overall result was that the patients who underwent early physical therapy did better than those who did not, with the former group reporting greater quality of life after one year. Accordingly, these patients also had higher direct healthcare costs. The key, however, is that the incremental cost-effectiveness for this group was below the typical willingness-to-pay threshold, and so early physical therapy was found to be cost-effective in the treatment of low back pain.
The study authors did note that the specific physical therapy protocol used on a patient may affect their results. They also noted that some observations were missing from their results and that the use of self-reporting may have created bias. As well, the health care costs used in the study were based on local pricing, and may not apply to all regions.
The application to the general public suffering a low back pain injury is that early physical therapy should always be considered as a treatment option. More research is of course needed to ascertain the most optimal physical therapy practices for this ailment.
Written by Raymond Quan, MASc, MBA
Reference: Fritz et al. “Cost-Effectiveness of Primary Care Management With or Without Early Physical Therapy for Acute Low Back Pain” SPINE Volume 42, Number 5, pp 285–290