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