Factors Impacting Physical Therapy Utilization for Patients With Nonspecific Low Back Pain: Retrospective Analysis of a Clinical Data Set.

OBJECTIVE: Factors predicting physical therapy utilization for lower back pain (LBP) remain unclear, limiting the development of value-based initiatives. The purpose of this study was to identify important factors that impact the number of physical therapist visits per episode of care for US adults with nonspecific LBP. METHODS: This study was a retrospective observational cohort study of a clinical dataset derived from 80 clinics of a single physical therapy provider organization. Research variables were categorized at the individual (patient) level and the organization (therapist, clinic) level. A hierarchical regression model was designed to identify factors influencing the number of physical therapist visits per episode of care. RESULTS: Higher out-of-pocket payments per visit, receipt of "active" physical therapy, longer average visit length, earlier use of physical therapy, and sex of the therapist (male) were found to predict fewer visits per episode of care. Percent change of function, prior receipt of physical therapy by the same provider organization, self-discharge from physical therapy, level of starting function, and therapist certification were found to predict more visits. Of the variance in number of visits, 8.0% was attributable to the health care organization. CONCLUSIONS: Individual factors, such as higher out-of-pocket payment, have a significant impact on reducing visits per episode of care and should be considered when developing value-based initiatives to optimize clinical and utilization outcomes. IMPACT: Payers use consumer-directed healthcare to reduce costs by discouraging utilization of low value services and encouraging use of low-cost providers. LBP is a costly condition for which physical therapy is a high-value treatment. This study shows that non-need factors predict the number of physical therapy visits per episode of care for patients with nonspecific LBP. Insurance benefit plans with lower out-of-pocket payments for physical therapy and higher reimbursement for active physical therapist interventions may facilitate appropriate utilization of high-value treatment for LBP.

Impact of Out-of-Pocket Expenditure on Physical Therapy Utilization for Nonspecific Low Back Pain: Secondary Analysis of the Medical Expenditure Panel Survey Data.

BACKGROUND: Physical therapy decreases low back pain, improves function, and may lead to decreased use of medical services. However, factors predicting physical therapy utilization for patients with low back pain are not well understood. OBJECTIVES: The purpose of this study was to identify the impact of out-of-pocket expenditure on physical therapy utilization for US adults with nonspecific low back pain. DESIGN: This study was a secondary analysis of retrospective Medical Expenditure Panel Survey data. METHODS: The participants were US adults with nonspecific low back pain. The outcome variable was the number of visits per episode of care. The research variable was out-of-pocket expenditure. Covariate variables were Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) component scores. Descriptive statistics and multiple linear regression analyses were performed. RESULTS: Three hundred fourteen adults met the inclusion criteria and submitted SF-12 scores, representing nearly 4 million adults. Out-of-pocket expenditure, physical component score, and the age-insurance category "18-64 years with public coverage only for all of the year or uninsured all of the year" negatively predicted visits per episode of care in the final regression model. LIMITATIONS: Limitations of the study included use of a nonexperimental design, lack of information about symptom severity and content of physical therapy, and SF-12 scores were not taken coincidental with the episode of care. CONCLUSIONS: Out-of-pocket expenditure negatively predicts physical therapy utilization. More research is needed to identify all factors influencing physical therapy utilization so that effective health policies may be developed.