Back Pain: Early Physiotherapy Pays for Itself by Reducing Other Healthcare Spen

A new study with nearly one million people finds that early physiotherapy for everyone would largely pay for itself by reducing spending on emergency departments, advanced imaging, and other healthcare spending.

Roughly one in six Australians have back problems.¹ That’s four million of us! What’s more, while the pain can come and go, two thirds of people with low back pain continue to experience pain a year after they first visited a doctor.² You can imagine the cost burden this puts on healthcare funds.

One strategy for reducing the cost of back pain is to withhold insurance-covered treatments from patients when they first present their complaints to healthcare professionals. When this is practiced, the first visit may involve some pain pills, advice to stay active, assurance, and recommendations to take up yoga.³ The practice is called wait-and-see. If the patient returns weeks later, still in pain, then physiotherapy may be considered. Practices vary. Some healthcare providers begin active treatment right away. One concern with wait-and-see is that patients have usually suffered for weeks before they visit a doctor. Another problem with wait-and-see is that we know physiotherapy gets better results for back pain when patients get seen within days of visiting the doctor.⁴ Finally, there has been little to no evidence that delaying active treatment reduces costs.

This past December, BMC Health Services Research published a high-powered study that gives us strong evidence to answer this question. They reviewed the medical records of 980,000 patients with back pain. Their study finds that, compared to people who get physiotherapy later or not at all, people who start physiotherapy within two weeks cost about the same. Early physiotherapy is associated with a cost savings of $70 in the first 30 days and a cost increase of $78 over the course of a year. In other words, making people wait for active back pain treatment does not create meaningful savings. The people in the group not receiving early physiotherapy spent less money on physiotherapy but ended up spending more money on advanced imaging, emergency department visits, injections, surgeons, etc.

References

Australian Institute of Health and Welfare 2019. Back problems. Cat. no. PHE 231. Canberra: AIHW. Viewed 22 April 2020, https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems
Costa LD, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012 Aug 7;184(11):E613-24.
Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines Committee of the American College of Physicians*. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017 Apr 4;166(7):514-30.
Arnold E, La Barrie J, DaSilva L, Patti M, Goode A, Clewley D. The effect of timing of physical therapy for acute low back pain on health services utilization: a systematic review. Archives of Physical Medicine and Rehabilitation. 2019 Jul 1;100(7):1324-38.
Marrache M, Prasad N, Margalit A, Nayar SK, Best MJ, Fritz JM, Skolasky RL. Initial presentation for acute low back pain: is early physical therapy associated with healthcare utilization and spending? A retrospective review of a National Database. BMC Health Services Research. 2022 Dec;22(1):1-9.