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Effectiveness and Downstream Healthcare Utilization for Patients That Received Early Physical Therapy Versus Usual Care for Low Back Pain

A Randomized Clinical Trial

Rhon, Daniel I. DSc∗,†; Miller, Robert B. DPT; Fritz, Julie M. PhD§

doi: 10.1097/BRS.0000000000002619

Study Design. Randomized controlled trial.

Objective. The aim of this study was to compare early physical therapy versus usual care in patients with low back pain.

Summary of Background Data. Early physical therapy (PT) has been associated with reduced downstream healthcare utilization in retrospective studies, but not investigated prospectively in the military health system.

Methods. Military service members seeking care from a general practitioner were recruited. Patients attended a 20-minute self-management class with focus on psychosocial resilience and then randomized to usual care only (UC) versus immediately starting a 3-week physical therapy program (PT). Primary outcome was the Oswestry Disability Index at 1 year. Secondary outcomes included Oswestry scores at 4- and 12-week follow-up, numeric pain rating scale, global rating of change, and healthcare utilization at 1 year. Analysis of covariance was used to compare differences between groups, significance set at 0.05. Trial Registration: NCT01556581

Results. A total of 119 patients (mean age 27.2 years; mean BMI 27.8 kg/m2; 15.1% female) enrolled (61 randomized to UC; 58 to PT). No between-group differences found on the Oswestry after 1 year. A between-group difference in Oswestry was present at 4 weeks (mean difference = 4.4; 95% CI: 0.41–10.1; P = 0.042) favoring PT. Total 1-year mean healthcare costs did not differ significantly between groups (UC $5037; 95 CI $4171–$6082 and PT $5299; 95 CI $4367–$6431). The portion of total mean healthcare costs related to low back pain was lower for UC ($1096; 95% CI $855–$1405) compared to PT ($2016, 95% CI $1570–$2590).

Conclusion. There was no difference between usual care and early PT after 1 year. PT provided greater improvement in disability after 4 weeks. As both groups improved, the impact of the education may have been underestimated. Patients in the PT group utilized greater back-pain-related healthcare resources, but overall healthcare costs did not differ compared to UC.

Level of Evidence: 2

Center for the Intrepid, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, TX, USA

Baylor University, Doctoral Program in Physical Therapy, San Antonio, TX, USA

U.S. Army Medical Department, Medical Professional Training Brigade, Joint Base San Antonio—Fort Sam Houston, TX, USA

§University of Utah, Salt Lake City, UT.

Address correspondence and reprint requests to Daniel I. Rhon, DSc, Center for the Intrepid, BAMC, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234; E-mail:,

Received 6 December, 2017

Revised 27 January, 2018

Accepted 14 February, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

Funds by the Peer Reviewed Orthopaedic Research Program (PRORP), which was supported through the Congressionally Directed Medical Research Program (CDMRP), were received in support of this work.

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