Abstract
Objective
To quantify and compare utilization of opioids, exercise therapy, and physical therapy
in the year before spine surgery.
Design
A retrospective cohort of surgical and claims data.
Setting
Beneficiaries of the Military Health System seen at Brooke Army Medical Center
Participants
Patients (N=411) undergoing surgery between January 1, 2014, and December 31, 2015,
identified retrospectively through the Surgical Scheduling System (S3) based on procedure
type (fusion, laminectomy, arthroplasty, vertebroplasty, and diskectomy).
Interventions
Elective lumbar spine surgery.
Main Outcome Measures
Health care utilization variables present during the full 12 months before surgery,
which included physical therapy services and visits for exercise therapy or manual
therapy procedures and opioid prescriptions.
Results
The mean age of participants was 44.8±11.7 years and 32.4% were female. In the year
before surgery, 143 (34.8%) patients had a physical therapy plan of care, 140 (34.1%)
had at least 1 visit that included exercise therapy, and only 60 (14.6%) had a minimum
of 6 exercise therapy visits. However, 347 (84.4%) patients received at least 1 opioid
prescription fill (mean of 6.1 unique fills).
Conclusions
Before elective lumbar spine surgery, opioid prescriptions were common but physical
therapy services and exercise therapy utilization occurred infrequently.
Keywords
List of abbreviations:
ACP (American College of Physicians), CPG (clinical practice guideline), CPT (Current Procedural Terminology), DoD (Department of Defense), IQR (interquartile range), LBP (low back pain), MHS (Military Health System), MDR (Military Health System Data Repository), OHI (other health insurance), S3 (Surgical Scheduling System)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiology of spine care: the back pain dilemma.Phys Med Rehabil Clin N Am. 2010; 21: 659-677
- Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians.Ann Intern Med. 2017; 166: 514-530
- Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview.Eur Spine J. 2018; 27: 2791-2803
- Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain.Ann Intern Med. 2005; 142: 776-785
- The influence of a guideline-concordant stepped care approach on downstream health care utilization in patients with spine and shoulder pain.Pain Med. 2019; 20: 476-485
- Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study.BMJ Open. 2016; 6e012938
- What is usual care for low back pain? A systematic review of health care provided to patients with low back pain in family practice and emergency departments.Pain. 2020; 161: 694-702
- Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction.Ann Intern Med. 2007; 146: 116-127
- Acute low back pain: systematic review of its prognosis.BMJ. 2003; 327: 323
- The prognosis of acute and persistent low-back pain: a meta-analysis.CMAJ. 2012; 184: E613-E624
- Associations between physical therapy and long-term outcomes for individuals with lumbar spinal stenosis in the SPORT study.Spine J. 2014; 14: 1611-1621
- Management patterns in acute low back pain: the role of physical therapy.Spine. 2012; 37: 775-782
- National trends in the surgical treatment for lumbar degenerative disc disease: United States, 2000 to 2009.Spine J. 2015; 15: 265-271
- Physician referrals to physical therapists for the treatment of spine disorders.Spine J. 2005; 5: 530-541
- Association of early physical therapy with long-term opioid use among opioid-naive patients with musculoskeletal pain.JAMA Netw Open. 2018; 1e185909
- Implications of early and guideline adherent physical therapy for low back pain on utilization and costs.BMC Health Serv Res. 2015; 15: 150
- The influence of exercise dosing on outcomes in patients with knee disorders: a systematic review.J Orthop Sports Phys Ther. 2018; 48: 146-161
- Treatment effect sizes for pain and disability are moderated by the delivery approach for mechanical diagnosis and therapy in a population with low back pain: a systematic review with a meta-regression approach.J Orthop Sports Phys Ther. 2019; : 1-40
- Meta-analysis: exercise therapy for nonspecific low back pain.Ann Intern Med. 2005; 142: 765-775
- Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs.Spine. 2012; 37: 2114-2121
- Low back pain.J Orthop Sports Phys The. 2012; 42: A1-A57
- What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review.Br J Sports Med. 2020; 54: 79-86
- Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases.Scand J Med Sci Sports. 2015; 25: 1-72
- Effectiveness of exercise therapy: a best-evidence summary of systematic reviews.Aust J Physiother. 2005; 51: 71-85
- Exercise therapy for chronic nonspecific low-back pain.Best Pract Res Clin Rheumatol. 2010; 24: 193-204
- Expenditures and health care utilization among adults with newly diagnosed low back and lower extremity pain.JAMA Netw Open. 2019; 2e193676
- A qualitative study of veterans on long-term opioid analgesics: barriers and facilitators to multimodality pain management.Pain Med. 2015; 16: 726-732
- Misconceptions and the acceptance of evidence-based nonsurgical interventions for knee osteoarthritis. A qualitative study.Clin Orthop RelatRes. 2019; 477: 1975-1983
- Making sense of low back pain and pain-related fear.J Orthop Sports Phys Ther. 2017; 47: 628-636
- Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial.JAMA. 2018; 319: 872-882
- Preoperative opioid use as a predictor of adverse postoperative self-reported outcomes in patients undergoing spine surgery.J Bone Joint Surg Am. 2014; 96: e89
- Preoperative opioid use and its association with perioperative opioid demand and postoperative opioid independence in patients undergoing spine surgery.Spine. 2014; 39: E1524-E1530
- The case for restraint in spinal surgery: does quality management have a role to play?.Eur Spine J. 2009; 18: 331-337
- The effectiveness of home-based exercise programs for low back pain patients.J Phys Therapy Sci. 2016; 28: 2727-2730
- Leveraging healthcare utilization to explore outcomes from musculoskeletal disorders: methodology for defining relevant variables from a health services data repository.BMC Med Inform Decis Mak. 2018; 18: 10
Article info
Publication history
Published online: May 12, 2020
Footnotes
The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Army, Department of Defense, or the US Government.
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
