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Does Adherence to the Guideline Recommendation for Active Treatments Improve the Quality of Care for Patients With Acute Low Back Pain Delivered by Physical Therapists?

Fritz, Julie M. PhD, PT, ATC*†; Cleland, Joshua A. PhD, DPT, FAAOMPT; Brennan, Gerard P. PhD, PT*

doi: 10.1097/MLR.0b013e318070c6cd
Original Article

Background: Numerous practice guidelines have been developed for patients with low back pain in an attempt to reduce inappropriate variations and improve the cost-effectiveness of care. Guideline implementation has received more research attention than the impact of adherence to guideline recommendations on outcomes and costs of care.

Objective: Examine the association between adherence to the guideline recommendation to use active versus passive treatments with clinical outcomes and costs for patients with acute low back pain receiving physical therapy.

Research Design: Retrospective review of patients with acute low back pain receiving physical therapy in 2004–2005. Adherence to the recommendation for active treatment was determined from billing records. Clinical and financial outcomes were compared between patients receiving adherent or nonadherent care.

Subjects: A total of 1190 patients age 18–60 years old with low back pain of less than 90 days duration in 10 clinics in 1 geographic region.

Measures: Clinical outcomes included the numeric pain rating and Oswestry disability questionnaire taken initially and at the completion of treatment. Financial outcomes included the number of sessions and charges for physical therapy care.

Results: Adherence rate was 40.4%. Adherence was greater for patients receiving workers' compensation (P < 0.05). Patients receiving adherent care had fewer visits and lower charges (P < 0.05), and showed more improvement in disability [adjusted mean difference for percentage improvement 25.8%, 95% confidence interval (CI): 21.3–30.4, P < 0.001] and pain (adjusted mean difference for percentage improvement 22.4%, 95% CI: 17.5–27.3, P < 0.001). Patients receiving adherent care were more likely to have a successful physical therapy outcome (64.7% vs. 36.5%, P < 0.001).

Conclusions: Adherence to the guideline recommendation for active care was associated with better clinical outcomes and reduced cost.

From the *Rehabilitation Agency, Intermountain Healthcare, Salt Lake City, Utah; †Division of Physical Therapy, University of Utah, Salt Lake City, Utah; and ‡Department of Physical Therapy, Franklin Pierce College, Concord, New Hampshire.

Reprints: Julie Fritz, PhD, PT, ATC, 520 Wakara Way, Salt Lake City, UT 84108. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.