Managed Physical Medicine

Study Summary: Odds of Opioid Prescription Reduced With Physical Therapy Consult

New research reveals how PT consultation, as compared with PT participation, affects opioid prescription rates and lower back pain (LBP)-related health care costs.

There is an established body of research indicating that physical therapy as a first-line treatment for uncomplicated lower back pain (LBP) can improve patient outcomes. A University of Utah research team recently dug a little deeper to examine the impact of the PT consultation, which often represents an interaction between patient and provider about the severity of the pain and the prognosis. The study aimed to determine whether “improved outcomes among PT cohorts may represent a combination of patient compliance with the PT recommendation and a patient’s belief about the nature and severity of the LBP.”

Objectives

The study’s focus was on Medicaid patients, who, on average, have worse overall health than the general population and who are 3 times more likely to develop LBP. Researchers looked at differences between Medicaid patients who received a PT consult and those who did not, as well as those who participated in PT and those who did not. A primary objective was to compare the impact of a PT consult and PT participation on opioid prescription rates and LBP-related health care costs over a year.

Findings

Using electronic medical records and claims data, several observations were made regarding the relationship between a patient’s health status and the rate of PT consult. Researchers found the odds of a PT consult increased if patients were prescribed non-steroidal anti-inflammatories or muscle relaxers and decreased if patients were tobacco users or had multiple comorbidities.

Importantly, the study found that the odds of opioid prescription over the year following the index visit reduced not only with PT participation (aOR = 0.47; 95% CI, 0.24 to 0.92) but also with PT consult alone (aOR = 0.65; 95% CI, 0.43 to 1.00), indicating that PT consult itself can positively impact patient outcomes. No differences in LBP-related healthcare costs were noted across the groups during this timeframe.


Thackeray A, Hess R, Dorius J, Brodke D, Fritz J. Relationship of Opioid Prescriptions to Physical Therapy Referral and Participation for Medicaid Patients with New-Onset Low Back Pain. J Am Board Fam Med. 2017;30(6):784-794.