Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges

Health Serv Res. 2015 Dec;50(6):1927-40. doi: 10.1111/1475-6773.12301. Epub 2015 Mar 16.


Objective: Compare health care utilization and charges for low-back-pain (LBP) patients receiving advanced imaging or physical therapy as a first management strategy following a new primary care consultation.

Data source: Electronic medical record (EMR) and insurance claims data.

Study design: Retrospective analysis of propensity-matched groups.

Data collection/extraction: Claims and EMR data were used. Utilization and LBP-related charges over a 1-year period were extracted from claims data.

Principal findings: In the propensity-matched sample (n = 406), advanced imaging recipients had higher odds of all utilization outcomes. Charges were higher with advanced imaging by an average $4,793 (95 percent CI: $3,676, $5,910).

Conclusions: For patients with LBP whom newly consulted primary care referred for additional management, advanced imaging as a first management was associated with higher health care utilization and charges than physical therapy.

Keywords: Physical therapy; imaging; low back pain; primary care.

MeSH terms

  • Adult
  • Comorbidity
  • Diagnostic Imaging / economics*
  • Electronic Health Records
  • Female
  • Health Services Research
  • Humans
  • Insurance Claim Review
  • Low Back Pain / diagnosis*
  • Low Back Pain / rehabilitation*
  • Male
  • Middle Aged
  • Physical Therapy Modalities / economics*
  • Primary Health Care / organization & administration*
  • Retrospective Studies