“Low back pain is the fifth most common reason for all physician visits in the United States,” says Michael Campian, DO who is a Physical Medicine and Rehabilitation resident at the University of Utah and an investigator on the study. Furthermore, healthcare costs related to low back pain are estimated to be as high as $238 billion annually, and the healthcare system is utilizing a number of methods to diagnose and treat the condition – from opioid use to expensive radiographs/advanced imaging to injections and surgery. We initiated this study to improve the care and satisfaction of people living with low back pain while attempting to reduce healthcare utilization and costs associated with its management.”
To address these issues, a team of physicians (Pamela Hansen, MD; Michael Campian, DO; Tyler Hedin, MD) , physical therapists (Julie Fritz, PT, PhD; Kim Cohee, DPT; Jake Magel, PT, DSc) and a hospital administrator (Matthew Huish, MBA), created a protocol that allows patients who typically have a four-to-six week wait time to see a PM&R spine specialist, to begin immediate (within 72 hours) treatment from a physical therapist while they are awaiting their appointment with the spine specialist.
“Physical therapy is important because we know that maintaining a normal lifestyle (i.e., continuing to work), staying active and early participation in an exercise program is extremely valuable in the management of low back pain,” says Dr. Campian.
The rapid access protocol (RAP) created by the researchers allows patients whose insurance covers physical therapy without a physician referral to undergo screening with a physical therapist and begin treatment as quickly as possible. During the initial screening, the physical therapist looks for any red flags that will need the spine specialist’s immediate attention. These include fevers, chills, unintentional weight loss, progressive neurologic symptoms, history of trauma to the back, or pain so severe they are unable to tolerate physical therapy. Barring any of these red flags, the patient will begin physical therapy immediately.
Since this spine research team initiated the RAP a little over one year ago, 93 patients have enrolled. On average, these patients’ self-reported a greater improvement in physical function (e.g., ability to walk, sustain physical activity, etc.) compared to those not enrolled in RAP. Additionally, the patients enrolled in RAP required fewer X-Rays than patients not enrolled (23.8 percent vs. 65.6 percent). They also required fewer MRIs (3.6 percent vs. 21.1 percent) and injections (4.8 percent vs. 19 percent).
“Through RAP, patients can start addressing their low back pain immediately, which will hopefully allow them to avoid inactivity and prevent loss of work – which has been demonstrated to negatively affect improvement of back pain – ultimately improving or resolving their back pain,” explains Dr. Campain of the initial success of the protocol. “This means they won’t have to wait and see a physician whom routinely refers to physical therapy as a first line treatment in most of these cases.”
Finally, the researchers noted that speeding the course of treatment and getting people functioning better earlier has potential to reduce healthcare costs. “Initially we set off to evaluate the success of rapid access to physical therapy in regards to improvement of low back pain and patient satisfaction, but we noted less frequent utilization of radiographs, MRIs and injections in these patients – leading us to believe this protocol has the ability to reduce healthcare costs,” explains Dr. Campain. “The next step would be to take a closer look at the reduction of healthcare cost with RAP, which is a significantly more complicated metric to evaluate.”
Editor’s Note: This press release contains updated numbers, which differ from those in the abstract submitted to the AAP Annual Meeting. These numbers reflect the ongoing RAP program.
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Rapid Access to Physical Therapy for Low Back Pain: A Continuous Quality Improvement Project
Michael Campian, DO; Tyler Hedin, MD; Pamela Hansen, MD; Matthew Huish, MBA; Julie Fritz, PT, PHD; Jake Magel, PT, DSC; Kim Cohee, DPT
Objectives: Low back pain (LBP) is the fifth most common reason for all physician visits in the U.S. The annual total LBP-related costs in the U.S. are estimated to be as high as $238 billion dollars. Despite numerous published clinical guidelines, the management of back pain has relied increasingly on the use of opioids, radiographs/advanced imaging, injections and surgery. The aim of this project is to improve the care and satisfaction of patients as well as reduce healthcare utilization/cost associated with management of LBP.
Design: Historically the average wait times to see a Physical Medicine and Rehabilitation (PM&R) spine specialist have been 4-6 weeks at which time a referral for a physical therapy evaluation was often generated. We developed a rapid access protocol (RAP) where patients with LBP who call to schedule an appointment with PM&R are also offered an earlier appointment with PT (within 72 hours). Qualified patients include those with LBP whose insurance covers PT without a physician referral. Patients are screened by PT at their initial visit for any “red flags” that warrant a physician visit prior to PT. These “red flags” include fevers, chills, unintentional weight loss, progressive neurologic symptoms, history of trauma, or pain so severe they are not able to tolerate PT.
Results: Since the protocol was initiated on 1/1/2016, 68 patients have enrolled in the RAP. Mean improvement of their physical function (PROMIS PFCAT) in the RAP was 5.6 vs 2.4 with our current protocol. Fewer radiographs (24.1% vs 63.3%), MRIs (0 vs 16.9%) and injections (1.9% vs 20.8%) were performed in the RAP group vs current protocol.
Conclusions: This study is still early and ongoing, but based on current results; the RAP for LBP has demonstrated a promising treatment route for producing better patient outcomes with improved patient function while reducing LBP-related healthcare utilization.
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