It never gets old hearing positive benefits of physical therapy.  It feels even better when research backs up what we all know to be true.  This week's blog highlights just that.

This week we are reviewing a study (cited below) that assessed the effects of physical therapy as the initial point of care for people experiencing neck and back pain. The study was coordinated between a large multi-clinic physical therapy practice and an insurance carrier in South Carolina. First let me say that it is absolutely amazing and commendable that they were able to get a large scale insurance carrier and physical therapy practice to work together. That in itself was an accomplishment and it gets even better. 

The researchers allowed patients with neck or back pain to choose their preferred access to care. Patients had a choice between either the traditional model (seeing a family care physician first, then following the chain of referrals) or direct access to physical therapy (seeing the physical therapist first).

This is an important issue, as the authors point out, because of the massive amounts of money spent and lost on spine related pain. The authors suggest that close to $85 billion dollars are spent yearly on spine related conditions with an additional $10 to $20 billion lost in productivity. Those are huge numbers and they have only gotten bigger. Aside from the huge monetary problems, neck and back pain effect a large part of the population, close to 25%. So it is important to understand how to best manage this group of people.

The results of the study were great for physical therapists.  First lets talk about the monetary benefits. The results showed that the group of patients that went directly to physical therapy saved over $1500 per patient on their cost of care compared to the group that chose to go the traditional route.  That equated to a total cost of savings of greater than $250,000 in the 171 patients that accessed physical therapy directly. This was due to reduced office visits to physicians, reduced imaging, reduced prescriptions, and reduced number of injections.  It should also be noted that the group that accessed physical therapy directly had fewer visits and less days in care, likely due to the value of early physical therapy care.

The second great result of this study was that the outcomes between the two groups were the same. There was a similar improvement in function and reduction in pain and disability between both groups.  That means there was no benefit of going through the traditional model.  Outcomes were just as good when care was initiated by physical therapy.

Lastly, and possibly the best part of the study showed that physical therapists are completely competent direct access providers.  When patients chose to see physical therapists first the research showed that there were no incidents of missed diagnosis or delays in care as a result of clinical decision making. Physical therapists are capable of finding red flags and determining patients that need to be referred out. This is significant as patient safety is often cited as a reason against direct access to physical therapy services.

Denninger T, Cook C, Chapman C, McHenry T, Thigpen C. The influence of patient choice of first provider on costs and outcomes: analysis from a physical therapy patient registry. Journal of Orthopaedic & Sports Physcal Therapy. 2018;48(2). 63-71.