The study, published in “Health Services Research,” was designed to determine if physical therapy reduced overall health care costs and patient outlay related to back pain. This included the number of opioid prescriptions and advanced imaging tests like MRIs and CT scans, as well as hospitalizations and ER visits.
The research found out that patients who saw a physical therapist before trying other treatments had an 89 percent lower probability of eventually needing an opioid prescription, a 28 percent lower probability of having any advanced imaging services, and a 15 percent lower probability of making one or more ER visits. Overall, patients saw significantly lower out-of-pocket costs — on the average $500 — when they visited a physical therapist first.
“The researchers examined 150,000 insurance claims that had the diagnosis of low back pain,” Dr. Bhuva said. “The researchers separated the participants into two groups. The first group went to physical therapy at the start of their treatment and the other group did not. The second group may have gone to physical therapy later in their treatment, but physical therapy was not used when they first began treatment.
“The researchers looked at the healthcare costs of both groups and, the patients who started with physical therapy realized considerable savings over the long run of their treatment. The reason for this is due to the fact that pain medications such as opioids, imaging, and visits to the emergency room are very expensive for the patient.
“I like to tell my patients who are undergoing physical therapy that this process is an ‘investment’ in their health. They put in the hard work initially, but the ‘return’ on this investment is a saving of money later on.
“This study also noted that the overall costs for low back pain can reach $100 billion a year. While it was not covered in this research, those of us involved in the practice of rehabilitative medicine know that two-thirds of these costs result from lower employee productivity and lost wages. If we can get patients back to work quickly through the use of physical therapy, we can reduce that loss in productivity costs.”
“It is also important to note that the practice of physical therapy medicine has never been better than it is today,” Dr. Bhuva said. “Physical therapists are highly trained and they can treat lower lumbar conditions such as strains, disc herniation, chronic pain from arthritis, sacroiliac pain and mild to moderate spinal stenosis.
“Most physical therapy is very ‘hands-on,’ which means that it works on the soft tissues and muscles. It also strengthens the body’s core and this can help align joints. All of this patient treatment is done at a lower cost than having multiple MRI’s, injections or surgeries.”
“PT is not a ‘quick fix,’” Dr. Bhuva said. “It requires time and effort, usually two sessions per week over a period of six to eight weeks. There are also situations when physical therapy doesn’t help.
“Our standard procedure is to start a patient on physical therapy and if they get no relief from the pain, we use tools such as MRI’s to see if we are missing something. There are also ‘red flag’ signs like significant weakness, balance issues, bowel or bladder issues – these suggest spinal cord compressions and often require surgery. However, the percentage of patients that fall into this category is very low.”
One of the most controversial issues in healthcare today is the use of opioids for pain relief.
“As this study showed, those who get physical therapy from the beginning of their treatment have an 89 percent lower probability of needing an opioid prescription,” Dr. Bhuva said. “The ‘opioid epidemic’ is definitely a hot topic among practitioners and patients. Some studies have suggested that over 150 people a day die from opioid overdoses. Anything we can do to avoid starting patients on long-term pain medications is worthwhile and physical therapy is definitely a part of this strategy.
“Finally, I believe that physical therapy or injections prior to surgery is ‘pre-hab’ rather than just rehab. The science behind this suggests that the stronger a patient’s supporting structure are core muscles and the flexibility of the spine -the better the recovery will be. Physical therapy may not eliminate the need for any kind of pain medications, but it reduces the dosage of these medications.”