急性腰痛的初始表现：早期物理治疗是否与医疗保健的利用和支出相关？对国家数据库的回顾性研究。
Initial presentation for acute low back pain: is early physical therapy associated with healthcare utilization and spending? A retrospective review of a National Database.
机构信息
Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5223, Baltimore, MD, 21287, USA.
Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, USA.
出版信息
BMC Health Serv Res. 2022 Jul 2;22(1):851. doi: 10.1186/s12913-022-08255-0.
BACKGROUND
Early initiation of physical therapy (PT) has been associated with lower healthcare costs and utilization; however, these studies have been limited to single institutions or healthcare systems. Our goal was to assess healthcare utilization and spending among patients who present for the first time with low back pain (LBP), according to whether they received early physical therapy (PT), using a large, nationwide sample; and geographic variation in rates of early PT and 30-day LBP-related spending.
METHODS
Using the Truven MarketScan database, we identified nearly 980,000 US adults ages 18-64 years who initially presented with acute LBP from 2010 through 2014 and did not have nonmusculoskeletal causes of LBP. Approximately 110,000 patients (11%) received early PT (≤2 weeks after presentation). We compared healthcare utilization and spending at 30 days and 1 year after presentation between patients who received early PT and those who did not. Alpha = 0.05.
RESULTS
At 30 days, early PT was associated with lower odds of chiropractor visits (odds ratio [OR] = 0.41, 95% confidence interval [CI] = 0.40-0.42), pain specialist visits (OR = 0.49, 95% CI = 0.47-0.51), emergency department visits (OR = 0.51, 95% CI = 0.49-0.54), advanced imaging (OR = 0.57, 95% CI = 0.56-0.58), orthopaedist visits (OR = 0.67, 95% CI = 0.66-0.69), and epidural steroid injections (OR = 0.68, 95% CI = 0.65-0.70). At 1 year, early PT was associated with less healthcare utilization. At 30 days, patients with early PT had lower mean LBP-related spending ($1180 ± $1500) compared with those without early PT ($1250 ± $2560) (P < 0.001). At 1 year, LBP-related spending was significantly less among patients who did not receive early PT ($2510 ± $3826) versus those who did ($2588 ± $3704). Early PT rates (range, 4-25%; P < 0.001) and 30-day LBP-related spending differed by state (range, $421 to -$410; P < 0.001).
CONCLUSION
Early PT for acute LBP was associated with less 30-day and 1-year healthcare utilization and less 30-day LBP-related spending. Early PT rates and 30-day spending differed by US state.
LEVEL OF EVIDENCE
IV.
背景
早期开展物理治疗（PT）与降低医疗保健成本和利用率相关；然而，这些研究仅限于单一机构或医疗系统。我们的目标是评估在使用大型全国性样本时，首次出现腰痛（LBP）的患者中，根据他们是否接受早期物理治疗（PT），评估医疗保健的利用和支出；以及早期 PT 率和 30 天 LBP 相关支出的地域差异。
方法
使用 Truven MarketScan 数据库，我们确定了近 98 万 18-64 岁的美国成年人，他们在 2010 年至 2014 年间首次出现急性 LBP，且没有非肌肉骨骼原因导致的 LBP。大约 110000 名患者（11%）接受了早期 PT（就诊后 2 周内）。我们比较了就诊后 30 天和 1 年时接受和未接受早期 PT 的患者的医疗保健利用和支出。alpha=0.05。
结果
在 30 天时，早期 PT 与以下情况的可能性降低相关：脊椎指压治疗师就诊（比值比[OR] = 0.41，95%置信区间[CI] = 0.40-0.42）、疼痛专家就诊（OR = 0.49，95% CI = 0.47-0.51）、急诊就诊（OR = 0.51，95% CI = 0.49-0.54）、高级影像学检查（OR = 0.57，95% CI = 0.56-0.58）、骨科医生就诊（OR = 0.67，95% CI = 0.66-0.69）和硬膜外类固醇注射（OR = 0.68，95% CI = 0.65-0.70）。在 1 年时，早期 PT 与较低的医疗保健利用率相关。在 30 天时，接受早期 PT 的患者的平均 LBP 相关支出（$1180±$1500）低于未接受早期 PT 的患者（$1250±$2560）（P < 0.001）。在 1 年时，未接受早期 PT 的患者的 LBP 相关支出（$2510±$3826）明显低于接受早期 PT 的患者（$2588±$3704）。早期 PT 率（范围：4-25%；P < 0.001）和 30 天 LBP 相关支出因州而异（范围：$421 至 -$410；P < 0.001）。
结论
急性 LBP 的早期 PT 与 30 天和 1 年的医疗保健利用率和 30 天的 LBP 相关支出减少相关。早期 PT 率和 30 天的支出因美国各州而异。
证据水平
IV。
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