A new study out of University of Washington (Seattle) and George Washington University (Washington, D.C.) shows very significant research to support the field of Physical Therapy. The study was published on May 23, 2018 in the the journal Health Services Research. The study reviewed and studied health care costs of individuals with diagnosis of low back pain from over 150,000 health care claims between 2009 and 2013.
“Overall, patients saw “significantly lower out-of-pocket costs — on the average, $500 — when they visited a physical therapist first,” says Bianca Frogner, a health economist at the University of Washington, and lead author on the study.”
In the study the use of opioids prescription drugs and advanced imagery procedures (MRI and CT scans), as well as emergency room (ER) visits and hospitalizations, were evaluated for effectiveness of delivering cost effective services for low back pain.
Patients who received physical therapy for low back pain before trying other treatments had an:
- 89 percent lower chance of needing opioid prescription pain relieving drugs,
- 28 percent lower chance of needing or requiring advanced imaging studies,
- 15 percent lower chance of needing to go to emergency room, or being hospitalized
Part of the study also suggests that patient education on the musculoskeletal system might actually understand this pain better than the average family physician. This is very true. In a recent study published in the Annuals of Family Medicine (May/June 2018) titled Physician Activities During Time Out of the Examination Room by Valerie Gilchrist, MD, et al.
On average, doctors in this study spend 8 hours and 8 minutes in the office per day and have 20 patient visits. Visits last an average of 17.5 minutes.
Approximately one third to one-half of a patient visit is spent entering data into the computer (depending on staff assistance in the room during visit to document the visit), lessening the patient face to face, and contact time to effectively listen and connect with the patient, determine the patient’s needs, desired outcome, plan of care, education and any treatment provided. It is not possible for clear guidance can occur during this short time. The education and optimal care for a person suffering from low back pain needs to be individually catered based on:
- Local, regional and other areas affecting or affected by low back pain –
Kenneth Harwood, a coauthor of the study and Director of Physical Therapy at George Washington University, says Physical Therapy can diminish a patient’s pain by physically moving the joints of the back, knee, or hip through a full range of motion, thereby decreasing the stiffness and immobility patients might feel.
- history of current condition –
As studies show, pain lasting greater than 4-6 weeks requires a different plan of care because tissue healing has been completed. The pain someone experiences is likely not related to the tissue that was injured. It is usually based on adaptive patterns, compensations that produce less competent movement and mobility, ineffective use of the body or parts to perform the required activities in one’s life, protective behaviors that actual complicate one ability to move and heal, and other behaviors related to past and current experiences relating to the pain and dysfunction a person experiences.
- demands and stressors in their life at work and at home,
- desires and wants for healing,
- what are the current strategies a person is using or doing to alleviate the pain, and improve their function in their life,
- what activities they are interested in doing for self care,
- what they miss and want to get back to when low back pain is not limiting them,
- cognitive abilities to understand pain signals and how to respond,
- learning capabilities,
- body awareness abilities,
- beliefs and false beliefs about their body and the pain being experienced,
- social and family dynamics around limited abilities and capacities secondary to pain,
- and more……
The average physician visit mentioned above is not enough time to even touch the first two variables.
“the evidence continues to mount supporting the implementation of more effective, non-invasive care for low back pain, and that many pricey standard treatments — including surgery and spinal injections — are often ineffective and can even worsen and prolong the problem.”
It’s also worth noting, that some patients who could benefit from physical therapy don’t get it, because of health insurance imposed restrictions from the policy they were either given by their employer or they signed up for. In addition, some health insurance policies place services in a different category of reimbursement, cost limits (at $2500 – $3000 per year, this would cover on average 8 to 10 visits based on cost billed) and lower reimbursement rates from the health insurance companies increasing out of pocket expenses. These become barriers to get the proper and effective care a person suffering from low back pain could receive.
Physical Therapy is a valuable resource to promotes healthy living through movement, nutrition, and education that can improve the health of a person’s spine.
“We need to look for better ways to help patients manage the current pain they have and prevent it from coming back in the future” says Bianca Frogner, adding that physical therapists “are well positioned to provide ideas on exercises, movement and ways of living to prevent the pain from getting worse — and hopefully from ever coming back, once it’s gone.”
Effective strategies are available at Moving Into Harmony to provide effective and efficient exercises that promote the health of the spine, preventing the debilitating affects of re-current low back pain, discovering movement patterns and how mobility affects the health of the spine and the body, and develop long term strategies and activities for a healthy spine.
Contact us about your interest and how we can help –