Physical Therapy Referral Rates Alongside Rising Opioid Prescription Rates in Patients With Low Back Pain
Low back pain (LBP) in Americans has a lifetime incidence of 11% to 80% (Spine). This is one of the main reasons for doctor visits, use of healthcare and worldwide reported disability. Because studies show that the overall prevalence of LRP has increased over the past decades, the burden of LRP care is likely to increase.
This is a cross-sectional observational study using the National Ambulatory and National Hospital Ambulatory Medical Care Surveys between 1997 and 2010. The aim of this study was to characterize national physical therapy (PT) referral trends during primary care provider (PCP) visits in the United States. Despite guidelines recommended by PT for the initial management of low back pain (LBP), national referral rates of the PT remain low. Race, ethnicity, age, payment type and PT referral rates were collected for patients aged 16 to 90 years who visited their PCP. Associations among demographic variables and PT references were determined using logistic regression.
Between 1997 and 2010, 170 million visits were estimated for LBP, leading to 17.1 million PT referrals. Average number of PCP visits associated with PT referrals remained stable at around 10.1% (odds ratio (OR) 1.00, 95% confidence interval (95% CI) 0.96-1.04), despite the prior finding of in associated with opioid prescriptions in the same timeframe. Lower PT referral rates were observed among visits by patients who were insured by Medicaid (OR 0.48, 95% CI 0.33-0.69 and Medicare (OR 0.50, 95% CI 0.35-0.72). In addition, visits not related to PT referrals were more likely associated with opioid prescriptions (OR 1.69, 95% CI 1.22-2.35).
Although therapies delivered by PTs are promoted as first-line treatment for LBP, the referral rates of PT remain low. There are also unequally lower referral rates in populations with more restrictive health plans and a simultaneous opioid prescription. These findings provide a broad overview of the PT recipe trend and isolate about associations that require further explorations.