Study: Costs reduced when low back pain treatment begins with physical therapy

A study in the scientific journal Health Services Research showed that initial referrals for physical therapy for patients with new episodes of low back pain (LBP) resulted in less than half the cost of imaging and generated lower costs associated with use of health care resources over time.

Physical therapist 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 patients who consulted with a primary care provider about uncomplicated LBP and were referred for management outside primary care within 6 weeks. They found that 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 (MRI). Also, average subsequent costs over the next year were nearly 72% lower for patients who began with a physical therapy referral—$1,871, compared with $6,664 for the imaging group over the same time period.

Authors discovered that patients who receive imaging as a first referral increased the likelihood of surgery and injections as well as specialist and emergency department visits within a year. They noted that 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, motivating them to seek additional care. Authors said that physical therapy may provide patients with an active approach to LBP, enhancing patients' perceived ability to self-manage their condition. Authors acknowledge that their study was limited to newly reported and uncomplicated LBP, and that patient-centered function or satisfaction outcomes were not recorded.

"This is one of many studies demonstrating that physical therapy is a cost-effective alternative to medication and surgery," said American Physical Therapy Association President Paul Rockar Jr, PT, DPT, MS. "Patients benefit from an active approach to their care and, in turn, society is transformed through the benefits from reduced financial burdens on our health care system."