New Study on the Relationship of a Physical Therapy Referral and Opioid Utilization

While there have been numerous studies that demonstrate the value of Physical Therapy in improving outcomes and reducing cost when used as a first line approach, few studies have examined what the impact of the Physical Therapy referral itself means. This is an important concept to understand since the initial consult with a primary care provider can set the tone for an entire course of care and mold the patient’s understanding of pain and what interventions may be more successful than others.

In a December 2017 study in the Journal of the American Board of Family Medicine, researchers looked at both the differences between referral and non-referral groups to PT for Low Back pain, but also the difference in groups that received a PT referral versus those that did not, regardless of whether the patient ever followed up and completed a course of PT. The study looked at several indicators that correlated to the Physical Therapy referral, while specifically highlighting the impact on opioid prescriptions written and a 1 year period following the initial consult. (https://goo.gl/EhHGG4).

Some of the more interesting findings of the study included:

• Patients were 1.8 times more likely to receive a referral to PT if they received an NSAID
• Patients were 25 times less likely to receive a PT referral if they had an advanced imaging or specialty care referral
• If the patient received multiple referrals in addition to the referral to PT (advanced imaging, specialty care, etc.), the patient was much less likely to attend Physical Therapy.
• Patients that received a Physical Therapy referral were 35% less likely to receive opioids for one year following their initial consult, regardless of whether or not the patient actually attended the Physical Therapy session.

The study is important in that it demonstrates the importance of the primary care provider’s initial conversations with the patient. Providers that are offering a conservative approach give the patient reassurance that their low back pain will improve without more potentially intrusive or potentially harmful interventions. If providers order numerous tests and procedures the patient will likely resort to the most invasive testing and pass on Physical Therapy. The study also reinforces evidence that staying active is important in patients with low back pain.

More needs to be done to ensure our medical providers are cognizant of the most current evidence as well as educated on how to have appropriate conversations their patients in regards to conservative care. As has been demonstrated in numerous studies Physical Therapy should be considered as the first alternative for low back pain in order to improve outcomes and reduce costs. Despite the very conclusive evidence supporting conservative care and Physical Therapy for low back pain, there continues to be a significant utilization of opioids, advanced imaging, and surgery which has proven to be costly to the patient as well as the healthcare industry.

The Physical Therapy profession as well needs to continue to do a better job educating the general public on the importance of trying PT first. As most states have adopted some form of Direct Access to Physical Therapy without a medical referral, many patients could avoid a trip to their primary care provider altogether.