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. 2022 Feb 2;17(2):237-246.
doi: 10.26603/001c.31720. eCollection 2022.

Musculoskeletal Imaging for Low Back Pain in Direct Access Physical Therapy Compared to Primary Care: An Observational Study

Michael S Crowell  1 , John S Mason  1 , John H McGinniss  1
Affiliations

Musculoskeletal Imaging for Low Back Pain in Direct Access Physical Therapy Compared to Primary Care: An Observational Study

Michael S Crowell et al. Int J Sports Phys Ther. .

Abstract

Background: Overutilization of diagnostic imaging is associated with poor outcomes and increased costs. Physical therapists demonstrate the ability to order diagnostic imaging safely and appropriately, and early access to physical therapy reduces unnecessary imaging, lowers healthcare costs, and improves outcomes.

Hypothesis/purpose: The primary purpose of this study was to compare rates of compliance with the National Committee for Quality Assurance - Healthcare Effectiveness Data and Information Set (HEDIS) recommendations for diagnostic imaging in low back pain between physical therapists and primary care providers in young, athletic patients.

Study design: Retrospective cohort study.

Methods: Military Health System Data Repository (MDR) data from January 2019 to May 2020 was reviewed for compliance with the low back pain HEDIS recommendation. The low back pain imaging HEDIS measure identifies the percentage of patients who did not have an imaging study (plain X-ray, MRI, CT Scan) ordered on the first encounter with a diagnosis of low back pain or in the 28 days following that first diagnosis. Chi-square tests compared HEDIS compliance rates, with α = 0.05 set a priori.

Results: From January 2019 to May 2020, in patients age 18-24, the MDR database identified 1,845 total visits for LBP identified in the Physical Therapy Clinic and 467 total visits for LBP in the Primary Care Clinic. In the Physical Therapy Clinic, 96.7% of encounters did not have imaging ordered within the first 28 days of onset of symptoms, compared with 82.0% in the Primary Care Clinic (p < .001).

Conclusions: Utilizing data from a national standardized healthcare performance measure, physical therapists practicing in a direct-access setting were significantly more likely than primary care providers to adhere to guidelines for low back pain imaging in young, athletic patients.

Level of evidence: Level 3.

Keywords: diagnostic imaging; low back pain; physical therapy direct-access.

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Conflict of interest statement

The authors have no relevant or material financial interests that relate to this study. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the United States Army or Department of Defense.

Figures

Figure 1.
Figure 1.. Healthcare Effectiveness Data and Information Set (HEDIS) Metric for Use of Imaging Studies for Low Back Pain.
Cases are excluded if there is evidence of a history of cancer, trauma within the past 90 days, intravenous drug use, cauda equina syndrome, human immunodeficiency virus (HIV), spinal infection, major organ transplant, or 90+ consecutive days of corticosteroid use.
Figure 2.
Figure 2.. Flow diagram of included and excluded cases.
See this image and copyright information in PMC

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References

    1. Analysis of appropriateness of outpatient CT and MRI referred from primary care clinics at an academic medical center: How critical is the need for improved decision support? Lehnert Bruce E., Bree Robert L. 2010J Am Coll Radiol. 7(3):192–197. doi: 10.1016/j.jacr.2009.11.010. - DOI - PubMed
    1. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. Murray Christopher J.L., Abraham Jerry, Ali Mohammed K., Alvarado Miriam, Atkinson Charles, Baddour Larry M., Bartels David H., Benjamin Emelia J., Bhalla Kavi, Birbeck Gretchen, Bolliger Ian, Burstein Roy, Carnahan Emily, Chen Honglei, Chou David, Chugh Sumeet S., Cohen Aaron, Colson K. Ellicott, Cooper Leslie T., Couser William, Criqui Michael H., Dabhadkar Kaustubh C., Dahodwala Nabila, Danaei Goodarz, Dellavalle Robert P., Des Jarlais Don C., Dicker Daniel, Ding Eric L., Dorsey E. Ray, Duber Herbert, Ebel Beth E., Engell Rebecca E., Ezzati Majid, Felson David T., Finucane Mariel M., Flaxman Seth, Flaxman Abraham D., Fleming Thomas, Forouzanfar Mohammad H., Freedman Greg, Freeman Michael K., Gabriel Sherine E., Gakidou Emmanuela, Gillum Richard F., Gonzalez-Medina Diego, Gosselin Richard, Grant Bridget, Gutierrez Hialy R., Hagan Holly, Havmoeller Rasmus, Hoffman Howard, Jacobsen Kathryn H., James Spencer L., Jasrasaria Rashmi, Jayaraman Sudha, Johns Nicole, Kassebaum Nicholas, Khatibzadeh Shahab, Knowlton Lisa Marie, Lan Qing, Leasher Janet L., Lim Stephen, Lin John Kent, Lipshultz Steven E., London Stephanie, Lozano Rafael, Lu Yuan, MacIntyre Michael F., Mallinger Leslie, McDermott Mary M., Meltzer Michele, Mensah George A., Micha Renata, Michaud Catherine, Miller Ted R., Mock Charles, Moffitt Terrie E., Mokdad Ali A., Mokdad Ali H., Moran Andrew E., Mozaffarian Dariush, Murphy Tasha, Naghavi Mohsen, Venkat Narayan K. M., Nelson Robert G., Olives Casey, Omer Saad B., Ortblad Katrina, Ostro Bart, Pelizzari Pamela M., Phillips David, Pope C. Arden, Raju Murugesan, Ranganathan Dharani, Razavi Homie, Ritz Beate, Rivara Frederick P., Roberts Thomas, Sacco Ralph L., Salomon Joshua A., Sampson Uchechukwu, Sanman Ella, Sapkota Amir, Schwebel David C., Shahraz Saeid, Shibuya Kenji, Shivakoti Rupak, Silberberg Donald, Singh Gitanjali M., Singh David, Singh Jasvinder A., Sleet David A., Steenland Kyle, Tavakkoli Mohammad, Taylor Jennifer A., Thurston George D., Towbin Jeffrey A., Vavilala Monica S., Vos Theo, Wagner Gregory R., Weinstock Martin A., Weisskopf Marc G., Wilkinson James D., Lopez Alan D., Zabetian Azadeh. 2013JAMA. 310(6):591–608. doi: 10.1001/jama.2013.13805. - DOI - PMC - PubMed
    1. Prevalence of back pain in sports: A systematic review of the literature. Trompeter Katharina, Fett Daniela, Platen Petra. 2017Sports Medicine. 47(6):1183–1207. doi: 10.1007/s40279-016-0645-3. - DOI - PMC - PubMed
    1. Diagnoses and mechanisms of musculoskeletal injuries in an Infantry Brigade Combat Team deployed to Afghanistan evaluated by the Brigade Physical Therapist. Roy Tanja C. Aug;2011 Military Medicine. 176(8):903–908. doi: 10.7205/MILMED-D-11-00006. - DOI - PubMed
    1. Bending the curve: The recent marked slowdown in growth of noninvasive diagnostic imaging. Levin David C., Rao Vijay M., Parker Laurence, Frangos Andrea J., Sunshine Jonathan H. 2011Am J Roentgenol. 196(1) doi: 10.2214/AJR.10.4835. - DOI - PubMed

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