• Deven A Karvelas, Sean D Rundell, Janna L Friedly, Alfred C Gellhorn, Laura S Gold, Bryan A Comstock, Patrick J Heagerty, Brian W Bresnahan, David R Nerenz, and Jeffrey G Jarvik.
• Rebound Orthopedics and Neurosurgery 200 NE Mother Joseph Place Suite 210 Vancouver, WA, 98664. Electronic address: dkarvelas@reboundmd.com.
• Spine J. 2017 Mar 1; 17 (3): 380-389.

BackgroundThe association between early physical therapy (PT) and subsequent health-care utilization following a new visit for low back pain is not clear, particularly in the setting of acute low back pain.PurposeThis study aimed to estimate the association between initiating early PT following a new visit for an episode of low back pain and subsequent back pain-specific health-care utilization in older adults.Design/SettingThis is a prospective cohort study. Data were collected at three integrated health-care systems in the United States through the Back Pain Outcomes using Longitudinal Data (BOLD) registry.Patient SampleWe recruited 4,723 adults, aged 65 and older, presenting to a primary care setting with a new episode of low back pain.Outcome MeasuresPrimary outcome was total back pain-specific relative value units (RVUs), from days 29 to 365. Secondary outcomes included overall RVUs for all health care and use of specific health-care services including imaging (x-ray and magnetic resonance imaging [MRI] or computed tomography [CT]), emergency department visits, physician visits, PT, spinal injections, spinal surgeries, and opioid use.MethodsWe compared patients who had early PT (initiated within 28 days of the index visit) with those not initiating early PT using appropriate, generalized linear models to adjust for potential confounding variables.ResultsAdjusted analysis found no statistically significant difference in total spine RVUs between the two groups (ratio of means 1.19, 95% CI of 0.72-1.96, p=.49). For secondary outcomes, only the difference between total spine imaging RVUs and total PT RVUs was statistically significant. The early PT group had greater PT RVUs; the ratio of means was 2.56 (95% CI of 2.17-3.03, p<.001). The early PT group had greater imaging RVUs; the ratio of means was 1.37 (95% CI of 1.09-1.71, p=.01.) CONCLUSIONS: We found that in a group of older adults presenting for a new episode of low back pain, the use of early PT is not associated with any statistically significant difference in subsequent back pain-specific health-care utilization compared with patients not receiving early PT.Copyright © 2016 Elsevier Inc. All rights reserved.

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