Abstract
BackgroundUnderstanding how much physiotherapy people receive before lumbar spine surgery could give insight into what people and clinicians consider an adequate trial of non-operative management. The aim of this study was to investigate physiotherapy utilisation and costs before lumbar spine surgery under a workers’ compensation claim in New South Wales (NSW), Australia.MethodsUsing data from the NSW State Insurance Regulatory Authority, we audited physiotherapy billing codes used before surgery for people who received lumbar spine surgery from 2010 to 2018. We summarised, separately for fusion and decompression, the time from initiation of physiotherapy to surgery, number of physiotherapy sessions people received before surgery, total cost of physiotherapy before surgery, and time from injury date to initiation of physiotherapy. All analyses were descriptive.ResultsWe included 3070 people (800 had fusion, 2270 decompression). Mean age (standard deviation, SD) was similar between those who received fusion and decompression [42.9 (10.4) vs. 41.9 (11.6)]. Compared to people who had fusion, those who had decompression were more likely to not have any physiotherapy before surgery (28.4% vs. 15.4%), received physiotherapy for a shorter duration before surgery [median (interquartile range, IQR): 5 (3 to 11) vs. 15 (4–26) months], were less likely to have physiotherapy for ≥2 years before surgery (5.6% vs. 27.5%), had fewer physiotherapy sessions before surgery [mean (SD): 16 (21) vs. 28 (35) sessions], were less likely to have > 50 physiotherapy sessions before surgery (6.8% vs. 18.1%), and had lower total physiotherapy-related costs [mean (IQR): $1265 ($0–1808) vs. $2357 ($453–2947)]. Time from injury date to first physiotherapy session was similar between people who had fusion and decompression [median (IQR): 23 (9–66) vs.19 (7–53) days].ConclusionsThere is variation in physiotherapy utilisation and costs before lumbar spine surgery for people funded by NSW Workers’ Compensation. Some people may not be receiving an adequate trial of physiotherapy before surgery, particularly before decompression surgery. Others may be receiving an excessive amount of physiotherapy before surgery, particularly before fusion.
Highlights
Understanding how much physiotherapy people receive before lumbar spine surgery could give insight into what people and clinicians consider an adequate trial of non-operative management
Time from initiation of physiotherapy to surgery, number of physiotherapy sessions, cost of physiotherapy and time from injury to initiation of physiotherapy Using physiotherapy billing codes, we identified whether a person received any physiotherapy as well as the time from initiation of physiotherapy to first lumbar spine surgery
The mean (SD) time to first lumbar spine surgery from injury date was higher for people who received fusion compared to decompression [21.6 (17.9) vs. 9.4 (10.6)] (Table 1)
Summary
Understanding how much physiotherapy people receive before lumbar spine surgery could give insight into what people and clinicians consider an adequate trial of non-operative management. Most people will experience some form of LBP in their lifetime [4], only a small percentage experience symptoms that limit their daily activity (7.3%) [5]. These people are thought to account for the majority of disability and costs associated with LBP [6, 7]. Rates of lumbar spine surgery are increasing in the United States of America (USA) [11] and United Kingdom [12]
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