Factors associated with care seeking from physicians, physical therapists, or chiropractors by persons with spinal pain: a population-based study

J Orthop Sports Phys Ther. 2011 Jul;41(7):467-76. doi: 10.2519/jospt.2011.3637. Epub 2011 Jun 7.


Study design: Secondary analysis of longitudinal population-based survey data.

Objectives: To investigate factors associated with care seeking for physician-referred physical therapy (MD/PT), as compared to physician-only (MD) or chiropractic-only (DC) care for spinal pain.

Background: Although a large proportion of ambulatory physical therapy visits are related to spinal pain, physical therapists are not the most commonly seen provider. The majority of visits are to physicians, followed by chiropractors. We attempted to understand more about this disparity by examining social and demographic factors that differentiate between persons who see these providers.

Methods: Episodes of care were constructed from participants in 2 panels from the Medical Expenditure Panel Survey who had spinal pain. The provider of care was identified for each episode, and logistic regression was used to determine factors associated with MD/PT use compared to MD use, and MD/PT use compared to DC use.

Results: The majority of patients (61%) received MD care for spinal pain, followed by those who received DC (28%) and MD/PT (11%) care. Female sex, higher levels of education, and higher income were significantly associated with MD/PT care over MD care. Increased age, female sex, lower self-health rating, and presence of at least 1 disability day were all significantly associated with MD/PT care over DC care.

Conclusion: Sociodemographic and clinical factors are associated with those who get MD/PT care as compared to MD or DC care. We found evidence of an access disparity for physical therapy and identified population characteristics that both increase and reduce the likelihood of physical therapy service use.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Chiropractic / statistics & numerical data*
  • Female
  • Health Care Surveys / statistics & numerical data
  • Humans
  • Longitudinal Studies
  • Low Back Pain / epidemiology
  • Low Back Pain / therapy*
  • Male
  • Middle Aged
  • Neck Pain / epidemiology
  • Neck Pain / therapy
  • Patient Acceptance of Health Care / statistics & numerical data
  • Physical Therapy Modalities / statistics & numerical data*
  • Physical Therapy Specialty
  • Physicians / statistics & numerical data*
  • Sex Factors