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Are Exercise and Physical Therapy Common Forms of Conservative Management in the Year Before Lumbar Spine Surgery?

      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)
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