Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs

Phys Ther. 2018 May 1;98(5):336-347. doi: 10.1093/ptj/pzy023.


Background: Physical therapy is an important treatment option for patients with low back pain (LBP). However, whether to refer patients for physical therapy and the timing of initiation remain controversial.

Objective: The objective of this study was to evaluate the impact of receiving physical therapy and the timing of physical therapy initiation on downstream health care utilization and costs among patients with acute LBP.

Design: The design was a retrospective cohort study.

Methods: Patients who had a new onset of LBP between January 1, 2009, and December 31, 2013, in New York State were identified and grouped into different cohorts on the basis of whether they received physical therapy and the timing of physical therapy initiation. The probability of service use and LBP-related health care costs over a 1-year period were analyzed.

Results: Among 46,914 patients with acute LBP, 40,246 patients did not receive physical therapy and 6668 patients received physical therapy initiated at different times. After controlling for patient characteristics and adjusting for treatment selection bias, health care utilization and cost measures over the 1-year period were the lowest among patients not receiving physical therapy, followed by patients with immediate physical therapy initiation (within 3 days), with some exceptions. Among patients receiving physical therapy, those receiving physical therapy within 3 days were consistently associated with the lowest health care utilization and cost measures.

Limitations: This study was based on commercial insurance claims data from 1 state.

Conclusions: When referral for physical therapy is warranted for patients with acute LBP, immediate referral and initiation (within 3 days) may lead to lower health care utilization and LBP-related costs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Costs and Cost Analysis
  • Female
  • Humans
  • Low Back Pain / economics*
  • Low Back Pain / rehabilitation*
  • Male
  • Middle Aged
  • New York
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Physical Therapy Modalities*
  • Retrospective Studies
  • Time-to-Treatment