The Effect of Timing of Physical Therapy for Acute Low Back Pain on Health Services Utilization: A Systematic Review

To synthesize literature about the effect of early physical therapy (PT) for acute low back pain (LBP) on subsequent health services utilization (HSU), compared to delayed PT or usual care. Electronic databases (MEDLINE, CINAHL, Embase) were searched from their inception to May 2018. Study selection...

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Bibliographic Details
Published in:	Archives of physical medicine and rehabilitation Vol. 100; no. 7; pp. 1324 - 1338
Main Authors:	Arnold, Elizabeth, La Barrie, Janna, DaSilva, Lisley, Patti, Meagan, Goode, Adam, Clewley, Derek
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-07-2019
Subjects:	Acute Disease Facilities and Services Utilization Health care costs Humans Low back pain Low Back Pain - therapy Physical Therapy Modalities Rehabilitation Time factors Health care costs APTA RCT OR PT MRI Low back pain CI HSU Physical therapy modalities Rehabilitation LBP Time factors
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Summary:	To synthesize literature about the effect of early physical therapy (PT) for acute low back pain (LBP) on subsequent health services utilization (HSU), compared to delayed PT or usual care. Electronic databases (MEDLINE, CINAHL, Embase) were searched from their inception to May 2018. Study selection included randomized control trials and prospective and retrospective cohort studies that investigated the association between early PT and HSU compared to delayed PT or usual care. Two independent authors screened titles, abstracts, and full-text articles for inclusion based on eligibility criteria, and a third author resolved discrepancies. Eleven out of 1146 articles were included. Two independent reviewers extracted data on participants, timing of PT, comparisons to delayed PT or usual care, and downstream HSU, and a third reviewer assessed the information to ensure accuracy and reach consensus. Risk of bias was assessed with the Downs and Black checklist using the same method. Eleven studies met eligibility criteria. Early PT is within 30 days of the index visit for acute LBP. Five out of 6 studies that compared early PT to delayed PT found that early PT reduces future HSU. Random effects meta-analysis indicated a significant reduction in opioid use, spine injection, and spine surgery. Five studies compared early PT to usual care and reported mixed results. Early PT for acute LBP may reduce HSU, cost, and opioid use, and improve health care efficiency. This review may assist patients, health care providers, health care systems, and third-party payers in making decisions for the treatment of acute LBP. •Early physical therapy is within 30 days of the index visit for acute low back pain.•Early physical therapy for acute low back pain reduces health services utilization.•Early vs delayed physical therapy is more cost effective.•Results are mixed for early physical therapy vs usual care.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	0003-9993 1532-821X
DOI:	10.1016/j.apmr.2018.11.025