A value proposition for early physical therapist management of neck pain: a retrospective cohort analysis.

Maggie E Horn,Steven Z George,Gerard P Brennan,Mark D Bishop,Jeffrey S Harman

doi:10.1186/s12913-016-1504-5

Abstract

BackgroundNeck pain is one of the most common reasons for entry into the healthcare system. Recent increases in healthcare utilization and medical costs have not correlated with improvements in health. Therefore there is a need to identify management strategies for neck pain that are effective for the patient, cost efficient for the payer and provided at the optimal time during an episode of neck pain.MethodsOne thousand five hundred thirty-one patients who underwent physical therapist management with a primary complaint of non-specific neck pain from January 1, 2008 to December 31, 2012 were identified from the Rehabilitation Outcomes Management System (ROMS) database at Intermountain Healthcare. Patients reporting duration of symptoms less than 4 weeks were designated as undergoing “early” management and patients with duration of symptoms greater than 4 weeks were designated as receiving “delayed” management. These groups were compared using binary logistic regression to examine odds of achieving Minimal Clinically Important Difference (MCID) on the Neck Disability Index (NDI) and Numerical Pain Rating Scale (NPRS). Separate generalized linear modeling examined the effect of timing of physical therapist management on the metrics of value and efficiency.ResultsPatients who received early physical therapist management had increased odds of achieving MCID on the NDI (aOR = 2.01, 95 % CI 1.57, 2.56) and MCID on the NPRS (aOR = 1.82, 95 % CI 1.42, 2.38), when compared to patients receiving delayed management. Patients who received early management demonstrated the greatest value in decreasing disability with a 2.27 percentage point change in NDI score per 100 dollars, best value in decreasing pain with a 0.38 point change on the NPRS per 100 dollars. Finally, patients receiving early management were managed more efficiently with a 3.44 percentage point change in NDI score per visit and 0.57 point change in NPRS score per visit.ConclusionsThese findings suggest that healthcare systems that provide pathways for patients to receive early physical therapist management of neck pain may realize improved patient outcomes, greater value and higher efficiency in decreasing disability and pain compared to delayed management. Further research is needed to confirm this assertion.

Highlights

Neck pain is one of the most common reasons for entry into the healthcare system
Patients Patients included in this study received physical therapist management for the primary complaint of neck pain between dates January 1, 2008 to December 31, 2012 from 13 outpatient physical therapy clinics located in Salt Lake City, Utah and surrounding regions
In this cohort we determined that when neck pain is managed early, within the first four weeks of symptoms, the patient is more likely to have a meaningful reduction in disability and pain, will demonstrate greater value per dollar for physical therapy and experience more efficient care when compared to Unadjusted Odds Ratio (OR)

Summary

Introduction

Neck pain is one of the most common reasons for entry into the healthcare system. Recent increases in healthcare utilization and medical costs have not correlated with improvements in health. Recent research supports that early physical therapist management for low back pain is recommended to improve outcomes in comparison to other management pathways such as advanced imaging, prescription medication or advanced care [8, 9], and can lead to lower downstream healthcare utilization and costs [10, 11]. This recommendation differs from previous recommendations where management is delayed to account for potential spontaneous recovery and advised only for patients that are resistant to recovery [12,13,14]. Despite neck pain being the second most common musculoskeletal disorder after low back pain [15, 16] and physical therapists being the most frequently visited healthcare provider for neck pain [17], the effect of early physical therapist management on outcomes has not been investigated in patients with neck pain

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