Physicians and physical therapists often work together to aid patients with low back pain (LBP). The optimal timing and pathway from physician to physical therapist remains to be determined.
In this study, therapists examine the type of physicians sending patients with low back pain to therapists and the outcomes of treatment. Type of physician refers to the type of medicine practiced such as the primary care physician, an occupational medicine physician, or specialist (e.g., orthopedic surgeon, neurologist, neurosurgeon, internal medicine).
The authors explored three things: 1) patient characteristics based on physician specialty, 2) link between physician type and patients’ final function, and 3) number of physical therapy visits (represents cost analysis). Patient characteristics included age, sex (male or female), level of activity and exercise, medications, and payer source. Other areas of interest also included how long the patients had their symptoms and length of time between physician examination and physical therapy referral.
After collecting and analyzing data on 7,971 patients, they found that physician referral does make a difference. Patients coming from primary care physicians and occupational medicine physicians had the best results. They finished therapy with more function, less pain, and in fewer visits compared with patients referred by other physician types.
A little closer look at the findings showed that patients who have higher function, who exercise at least three times a week, and who are covered by a health maintenance organization (HMO) or preferred provider organization (PPO) had better results at discharge. Patients with the poorest function were older, on Medicaid, and had a longer duration of symptoms.
Other studies have looked at outcomes based on patient work/employment status, type of insurance coverage (including worker’s compensation), and acute versus chronic low back pain. This is one of the first studies starting to look at patterns and sources of referral to physical therapy for this condition.
This study showed that referral source was associated with functional outcome and that patients referred by a specialist tended to have more chronic pain or a more complex clinical picture. Patients are referred sooner (during acute phase of pain) by occupational medicine physicians. That may explain why they respond better and faster compared with patients with chronic pain most often referred by specialist physicians.
The hope from studies like this is to facilitate patient referral from physician to therapist in order to improve patient outcomes. Earlier referral has been shown to reduce overall costs while helping patients reduce pain and improve function. Delays in referral with longer duration of symptoms and shift from acute to chronic status are linked with worse final outcomes.