Explanatory multivariate modeling for disability, pain, and claims in patients with spine pain via a physical therapy direct access model of care

Article type: Research Article

Authors: Green, Christopher E.^a | Pastore, Anthony^a | Cronley, Leah^b | Walker, Merritt D.^b | Thigpen, Charles A.^{c; d} | Cook, Chad E.^b | Givens, Deborah L.^{a; *}

Affiliations: [a] Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA | [b] Doctor of Physical Therapy Division, Department of Orthopaedics, Duke University, Durham, NC 27705, USA | [c] ATI Physical Therapy, University of South Carolina, Greenville, SC 29681, USA | [d] Center for Effectiveness Research in Orthopaedics, University of South Carolina, Greenville, SC 29681, USA

Correspondence: [*] Corresponding author: Deborah L. Givens, Division of Physical Therapy, UNC at Chapel Hill, 3032 Bondurant Hall, CB 7135, Chapel Hill, NC 27599, USA. Tel.: +1 919 843 8660; E-mail: deborah_givens@med.unc.edu.

Abstract: BACKGROUND: Direct access physical therapy (DAPT) may result in improved patient outcomes and reduced healthcare costs. Prognostic factors associated with spine-related outcomes and insurance claims with DAPT are needed. OBJECTIVE: To identify factors that predict variations in outcomes for spine pain and insurance claims using DAPT. METHODS: Individuals (N = 250) with spine pain were analyzed. Outcomes were classified into High, Low, or Did Not Meet minimal clinically important difference (MCID) scores. Claims were categorized into low, medium, or high tertiles. Prognostic variables were identified from patient information. RESULTS: Females were more likely to meet High MCID (odds ratio [OR] 2.84 (95% CI = 1.32, 6.11) and Low MCID (OR 2.86, 95% CI = 1.34, 6.10). Higher initial ODI/NDI scores were associated with High MCID (OR 1.04, 95% CI = 1.07, 1.22) and Low MCID (OR 0.91, 95% CI = 0.77, 1.07). Odds of a high claim were lowered by the absence of imaging (OR 0.04, 95% CI = 0.02, 0.09) and an active versus passive treatment (OR 0.38, 95% CI = 0.18, 0.80). CONCLUSION: Females and higher initial disability predicted favorable outcomes. The novel introduction of claims into the prognostic modeling supports that active interventions and avoiding imaging may reduce claims.

Keywords: Prognosis, low back pain, neck pain, health care costs, direct access

DOI: 10.3233/BMR-171074

Journal: Journal of Back and Musculoskeletal Rehabilitation, vol. 32, no. 5, pp. 769-777, 2019