MGH Institute of Health Professions, Boston, Massachusetts.
Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island.
J Geriatr Phys Ther. 2022;45(3):E145-E154. doi: 10.1519/JPT.0000000000000328. Epub 2021 Oct 12.
Lumbar spinal stenosis (LSS) is associated with high health care utilization for older adults. Physical therapy (PT) offers low medical risk and reduced cost burden with functional outcomes that appear to be equivalent to higher risk interventions such as surgery. However, it is unknown whether receipt of PT following incident LSS diagnosis is associated with reduced health care utilization. The objectives of this study were to: (1) compare health characteristics for Medicare beneficiaries who received outpatient PT within 30 days of incident LSS diagnosis to those who did not; (2) compare the 1-year utilization rates for specific health care services for these 2 groups; and (3) quantify the likelihood of progression to specific health services based on the receipt of PT.
This was a retrospective cohort study using nationally representative claims data for Medicare Part B beneficiaries between 2007 and 2010. Lumbar spinal stenosis was determined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Beneficiaries 65 years and older were classified into 2 groups (PT and no PT) based on receipt of PT within 30 days of initial diagnosis. Baseline characteristics were identified at incident diagnosis. Hazard ratios (HRs) were estimated for the risk of receiving health services outcomes including spinal surgery, spinal injections, chiropractic care, advanced imaging, spinal radiographs, opioid medication, nonopioid analgesics, and hospitalizations beginning on day 31 up to 1 year following incident LSS diagnosis.
Among 60 646 Medicare beneficiaries with incident LSS who met the inclusion criteria, 1124 were classified in the PT group and 59 522 in the no PT group. Compared with the PT group, beneficiaries in the no PT group had a greater risk of having hospitalizations (HR = 1.40), opioid medications (HR = 1.29), spinal surgery (HR = 1.29), and spinal radiographs (HR = 1.19) within 1 year.
Fewer than 2% of Medicare beneficiaries received PT within 30 days of initial LSS diagnosis. Receipt of PT was associated with less utilization of higher risk and costly health services for 1 year. These results may inform practitioners when making early decisions about rehabilitative care for older adults with LSS.
腰椎管狭窄症（LSS）与老年人高医疗保健利用率相关。物理疗法（PT）提供低医疗风险和降低成本负担，同时具有与更高风险干预（如手术）相当的功能结果。然而，尚不清楚在腰椎管狭窄症诊断后接受 PT 是否与减少医疗保健利用率相关。本研究的目的是：（1）比较在腰椎管狭窄症诊断后 30 天内接受门诊 PT 的 Medicare 受益人与未接受 PT 的受益人的健康特征；（2）比较这两组患者在特定医疗服务方面的 1 年使用率；（3）根据接受 PT 的情况，量化向特定医疗服务进展的可能性。
这是一项回顾性队列研究，使用了 2007 年至 2010 年 Medicare 部分 B 受益人的全国代表性索赔数据。腰椎管狭窄症使用国际疾病分类，第九修订版，临床修正（ICD-9-CM）代码确定。65 岁及以上的患者根据在初始诊断后 30 天内接受 PT 的情况分为两组（PT 组和非 PT 组）。在初始诊断时确定基线特征。从腰椎管狭窄症诊断开始的第 31 天至 1 年，估计了接受医疗服务结果（包括脊柱手术、脊柱注射、脊椎按摩疗法、高级影像学、脊柱 X 光片、阿片类药物、非阿片类镇痛药和住院治疗）的风险的风险比（HRs）。
在符合纳入标准的 60646 名患有腰椎管狭窄症的 Medicare 受益人中，有 1124 人被归入 PT 组，59522 人被归入非 PT 组。与 PT 组相比，非 PT 组的住院治疗（HR = 1.40）、阿片类药物（HR = 1.29）、脊柱手术（HR = 1.29）和脊柱 X 光片（HR = 1.19）的风险更高。
不到 2%的 Medicare 受益人的腰椎管狭窄症初始诊断后 30 天内接受了 PT。PT 的使用与 1 年内更高风险和更高成本医疗服务的使用率降低有关。这些结果可能为医生在为患有腰椎管狭窄症的老年人做出早期康复治疗决策时提供信息。
