Direct access of physical therapy leads
to lower costs for neck pain patients

Lack of improvement in outcomes may be due to type and timing of care provided
Neck and back pain are two of the most common conditions associated with disability, and while costs continue to soar, there is little to suggest an improvement in patient outcomes. This lack of notable improvement may be due to the type and timing of care: many patients are given treatments that provide nominal to no effect, and access to care is poor or delayed. While traditional care models often deliver inappropriate treatments that don't align with current guidelines, direct access to physical therapy has been associated with fewer days of care and lower costs. Noting that more research was needed on the influence of direct access on costs and outcomes, a retrospective study was conducted to compare costs between direct and traditional access to physical therapy for neck or back pain.

All patients undergo the same program
This study was based on a program that offered patients with neck or back pain the choice of accessing physical therapy either traditionally or directly. A final sample of 447 patients was used for the analysis, and all patients were managed with the same physical therapist-led treatment program, which included spinal manipulation, therapeutic exercise, and patient education. Patients were assessed using several self-reported outcome measures for pain, disability, and overall health status, and then overall costs were compared between groups.

Choosing physical therapy first may save patients time and lower costs
A majority (61.7%) of the 447 patients chose the traditional model for accessing physical therapy. Regardless of how patients accessed care, 79% completed the program and most displayed good clinical improvements in pain and disability, with no significant between-group differences. Direct access patients also had significantly fewer treatment sessions and days in care, and incurred an average cost of $1,543 less than those who accessed care traditionally. There were also no significant differences in adverse events between groups. These findings suggest that direct access to physical therapy may be a more cost-effective approach for neck and/or back pain that leads to similar patient outcomes. While additional research is still needed, it appears that clinicians can comfortably encourage patients with neck pain to visit a physical therapist first in order to more efficiently begin their path to recovery with a lower healthcare burden.

-Summarized by Greg Gargiulo

-As reported in the February '18 issue of JOSPT