North Carolina Physical Therapy Association

Early Access to Physical Therapy

Physical therapists play an important role in the management of low back pain.  The usual path to physical therapy can be a bit twisted with delays along the way.  Typically the patient may have multiple physician visits, medication, radiographic diagnostics, and interventional procedures.  Physical therapy may be referred to at any time during this process.  So my question is, “when is the best time to refer to (or access) physical therapy”?

Recently Fritz et. al. (pubmed link) have published new findings on this.  It is still in a publish before print format in the journal Spine.  What did they find?  Well it may be no surprise to physical therapists that treat low back pain, but they concluded “Early physical therapy following a new primary care consultation was associated with reduced risk of subsequent healthcare compared with delayed physical therapy”.  This was a study of over 32,000 patients.  Early physical therapy was categorized as less than 14 days.  Early physical therapy resulted in lower costs for the care of low back pain including decreased need for multiple physician visits, advanced imaging, injections, and surgery as compared to delayed access to a physical therapist.

I am talking costs here, but the lower costs are related to patient improvements and functional gains.

These findings seem to follow the 2006 Virginia-Mason Medical Center (link) study with Aetna and Starbucks.   They found that early referral to physical therapy (see image) for low back pain resulted in earlier return to work and lower costs.  In their study time they found that patients with a back injury could be seen in about a day.  Only 6% of patients needed to take time off of work.

This article in USA today (link) looked at Intel’s plan of getting patients into PT within 48 hours.  So what happened?  Well treatment time went from an average of 52 days to 19 days, costs of care dropped 10-30%, and there was higher satisfaction and quicker return to work.

It seems that access to what we do can help greatly.  As physical therapists we are educated in screening for red flags and are trained to refer out when the condition is beyond our scope of practice or required further diagnosis.  In North Carolina we do have direct access to provide patient care.  So how good are we at getting patients this early access?  How soon do you see your low back patients?  Do you get this information to your referral sources?

I would like to hear what you think.  

Mike Hoy, PT, DPT

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5 thoughts on “Early Access to Physical Therapy

  1. I Great post. I think as PT’s we can be really good at delivering this early access and same day evaluation and treatment. I think the main thing holding keeping this crime being a large scale reality is the public’s perception of what physical therapy is. People do not know that they can see a PT directly and they think they either need to see a orthopaedic surgeon for an MRI or a chiropractor for an “adjustment,” (whatever that is?).

    I typically see patients after they have already received medical interventions and even physical therapy that has not succeeded, but relish the opportunity to treat a patient within 14 days of the onset of their low back pain.

    In my practice I do not have physicians as significant referral sources, so I concentrate on marketing directly to potential patients and educating the public through online articles, videos and blog posts. Private practices really do not have the advertising budget to educate the public the way our national association can with it’s pooled resources.

    I’m looking forward to the day when physical therapists are thought of as the profession that people need to see first when they have pain or an injury.

  2. Thanks for the blog post. I think every PT knows this. As a former Army PT with direct access, soldiers often see PTs first for all musculoskeletal complaints as per normal routine. I’m happy to see there is starting to be published evidence to back up this obvious-to-us point. I find that with my own small direct-access, no-insurance practice, every single person I speak with is surprised to hear that they can and ought to see a PT as soon as they can, even immediately and without referral. I hope that is common knowledge someday. This is the first step.

  3. Michael Essa, MA, ATC, LAT, CSCS, SPT on said:

    The Fritz, Flynn, and Childs group developed a CPR’s to determine which patients with low back pain would benefit from manipulation. They found that 5 variables predicted success with manipulation (a pt who was positive on the rule had a 92% chance of a successful outcome). These variables were pain < 14 days, no pain below the knees, greater than 35 degrees of hip IR (in at least one hip), low FABQ score, and segmental hypo-mobility1. An interesting spin off was that 2 variables explained the bulk of the CPR, pain less than 14 days and no pain below the knee2. My thought is that the early intervention component is extremely important for both manipulation and LBP in general because the earlier we intervene the lower the probability of developing secondary impairments (like deconditioning, decreased strength, decreased ROM, hypersensitive pain pathways, and fear avoidance). The above findings make perfect sense.…at least in this student's opinion!!!

    1.Childs JD, Fritz JM, Flynn TW, Irrgang JJ, Johnson KK, Majkowski GR, Delitto A. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med. 2004 Dec 21;141(12):920-8.

    2.Fritz JM, Childs JD, Flynn TW. Pragmatic application of a clinical prediction rule in primary care to identify patients with low back pain with a good prognosis following a brief spinal manipulation intervention.
    BMC Fam Pract. 2005 Jul 14;6(1):29.

  4. Pingback: Early Access to Physical Therapy | ActivePTblog

  5. Yes, early access makes a HUGE difference in the the speed of recovery. It’s like any other undetected root problem…left untreated it will make things worse. The longer you walk with a limp, for example, the more strain you put on your other joints and ligaments. It only makes sense for physical therapists to get a jump start of treatment.

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