A value proposition for early physical therapist management of neck pain: a retrospective cohort analysis.

Horn, Maggie E

Brennan, Gerard P

George, Steven Z

Harman, Jeffrey S

Bishop, Mark D

England

2016-09-14T14:08:00Z

2016-07-12

BACKGROUND: Neck pain is one of the most common reasons for entry into the healthcare system. Recent increases in healthcare utilization and medical costs have not correlated with improvements in health. Therefore there is a need to identify management strategies for neck pain that are effective for the patient, cost efficient for the payer and provided at the optimal time during an episode of neck pain. METHODS: One thousand five hundred thirty-one patients who underwent physical therapist management with a primary complaint of non-specific neck pain from January 1, 2008 to December 31, 2012 were identified from the Rehabilitation Outcomes Management System (ROMS) database at Intermountain Healthcare. Patients reporting duration of symptoms less than 4 weeks were designated as undergoing "early" management and patients with duration of symptoms greater than 4 weeks were designated as receiving "delayed" management. These groups were compared using binary logistic regression to examine odds of achieving Minimal Clinically Important Difference (MCID) on the Neck Disability Index (NDI) and Numerical Pain Rating Scale (NPRS). Separate generalized linear modeling examined the effect of timing of physical therapist management on the metrics of value and efficiency. RESULTS: Patients who received early physical therapist management had increased odds of achieving MCID on the NDI (aOR = 2.01, 95 % CI 1.57, 2.56) and MCID on the NPRS (aOR = 1.82, 95 % CI 1.42, 2.38), when compared to patients receiving delayed management. Patients who received early management demonstrated the greatest value in decreasing disability with a 2.27 percentage point change in NDI score per 100 dollars, best value in decreasing pain with a 0.38 point change on the NPRS per 100 dollars. Finally, patients receiving early management were managed more efficiently with a 3.44 percentage point change in NDI score per visit and 0.57 point change in NPRS score per visit. CONCLUSIONS: These findings suggest that healthcare systems that provide pathways for patients to receive early physical therapist management of neck pain may realize improved patient outcomes, greater value and higher efficiency in decreasing disability and pain compared to delayed management. Further research is needed to confirm this assertion.

http://www.ncbi.nlm.nih.gov/pubmed/27405318

10.1186/s12913-016-1504-5

1472-6963

https://hdl.handle.net/10161/12756

eng

Springer Science and Business Media LLC

BMC Health Serv Res

10.1186/s12913-016-1504-5

Disability

Efficiency

Neck pain

Pain

Value

A value proposition for early physical therapist management of neck pain: a retrospective cohort analysis.

Journal article

Horn, Maggie E|0000-0002-3963-7389

George, Steven Z|0000-0003-4988-9421

http://www.ncbi.nlm.nih.gov/pubmed/27405318

253

Clinical Science Departments

Duke

Duke Clinical Research Institute

Institutes and Centers

Orthopaedics

Orthopaedics, Physical Therapy

School of Medicine

Published online

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