• Sean D Rundell, Karen J Sherman, Patrick J Heagerty, Charles Mock, and Jeffrey G Jarvik.
• S.D. Rundell, PT, DPT, PhD, Department of Rehabilitation Medicine and Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington. Mailing address: University of Washington, Box 359455, 4333 Brooklyn Ave NE, Seattle, WA 98105 (USA). srundell@uw.edu.
• Phys Ther. 2015 Feb 1;95(2):190-201.

BackgroundAmong older adults, it is not clear how different types or amounts of physical therapy may be associated with improvements in back pain and function.ObjectiveThe study objective was to investigate the association between types or amounts of physical therapist services and 1-year outcomes among older adults with back pain.DesignThis was a prospective cohort study.MethodsA total of 3,771 older adults who were enrolled in a cohort study and who had a new primary care visit for back pain participated. Physical therapy use was ascertained from electronic health records. The following patient-reported outcomes were collected over 12 months: back-related disability (Roland-Morris Disability Questionnaire) and back and leg pain intensity (11-point numerical rating scale). Marginal structural models were used to estimate average effects of different amounts of physical therapy use on disability and pain for all types of physical therapy and for active, passive, and manual physical therapy.ResultsA total of 1,285 participants (34.1%) received some physical therapy. There was no statistically significant gradient in relationships between physical therapy use and back-related disability score. The use of passive or manual therapy was not consistently associated with pain outcomes. Higher amounts of active physical therapy were associated with decreased back and leg pain and increased odds of clinically meaningful improvements in back and leg pain relative to results obtained with no active physical therapy.LimitationsThe fact that few participants had high amounts of physical therapy use limited precision and the ability to test for nonlinear relationships for the amount of use.ConclusionsHigher amounts of active physical therapy were most consistently related to the greatest improvements in pain intensity; however, as with all observational studies, the results must be interpreted with caution.© 2015 American Physical Therapy Association.

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