Before Back Surgery Physiotherapy Utilization Patterns in New South Wales

Workers’ compensation records show that in New South Wales, before decompression surgery, more than a quarter of patients receive no physiotherapy. Nearly another quarter of patients receive only one to eight physiotherapy sessions before decompression surgery

Workers’ compensation records show that in New South Wales, before decompression surgery, more than a quarter of patients receive no physiotherapy. Nearly another quarter of patients receive only one to eight physiotherapy sessions before decompression surgery. On the other hand, nearly six percent received physiotherapy for two years or more. This according to the work of Joshua Zadro, University of Sydney, and his research col[1]leagues. BioMed Central scheduled their first[1]of-its-kind study for publication in December and released it early electronically.1

The authors conclude that these physiotherapy utilisation patterns suggest both underutilisation and overutilisation. Low back pain ranks as the world’s leading cause of years lived with disability, resulting in a high economic burden.2 Most people will experience LBP in their lifetime, but for 7%, the condition limits daily activity.3 In Australia, direct costs accumulate to over $5 billion annually, with indirect costs projected at signif[1]icantly higher levels. 4 Zadro et al. acknowledge that they structured their study only to report utilization patterns before surgeries. From this data, one cannot glean what percentage of patients receiving few physiotherapy visits were assessed as not suitable for exercise therapy and referred to surgery appropriately. Nevertheless, guide[1]lines call for conservative rehabilitation before back surgery.5,6 Zadro and colleagues find it likely that there is opportunity to achieve more cost-effective and less invasive healthcare in NSW.

Lumbar spine surgeries in Australia cost rough[1]ly $53,000. Compare that to the cost of physi[1]otherapy before decompression surgery at only $1,265.7 Early physiotherapy has been shown to reduce the risk of surgery 55%.8 Broader and earlier utilization of physiothera[1]py may be one strategy that can improve patient outcomes and reduce costs in NSW’s workers’ compensation system.

References

 1. Zadro JR, Lewin AM, Kharel P, Naylor J, Maher CG, Harris IA. Physiotherapy utilisation and costs before lumbar spine surgery: a retrospective analysis of workers compensation claims in Australia. BMC Musculo[1]skeletal Disorders. 2021 Dec;22(1):1-0.

2. James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analy[1]sis for the Global Burden of Disease Study 2017. The Lancet. 2018 Nov 10;392(10159):1789-858.

3. Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, Carter A, Casey DC, Charlson FJ, Chen AZ, Coggeshall M. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016 Oct 8;388(10053):1545-602.

4. Arthritis and Osteoporosis Victoria. A Problem Worth Solving: The Rising Cost of Musculoskeletal Condi[1]tions in Australia: a Report. Arthritis and Osteoporosis Victoria; 2013.

5. National Institute for Health and Care Excellence (NICE) Guidelines. Low back pain and sciatica in over 16s: assessment and management. November 2016.

6. Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CW, Chenot JF, van Tulder M, Koes BW. Clinical prac[1]tice guidelines for the management of non-specific low back pain in primary care: an updated overview. European Spine Journal. 2018 Nov;27(11):2791-803.

7. Australian Commission on Safety and Quality in Health Care. Prioritised List of Clinical Domains for Clini[1]cal Quality Registry Development. Final Report Sydney. ACSQHC; 2016. 8. Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary care referral of patients with low back pain to phys[1]ical therapy: impact on future health care utilization and costs. Spine. 2012 Dec 1;37(25):2114-21.

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