Relationship of opioid prescriptions to physical therapy referral and participation for medicaid patients with new-onset low back pain

Introduction: physical therapy (pt) early in the management of low back pain (lbp) is associated with reductions in subsequent health care utilization and lbp-related costs. the objectives of this study were to 1) examine differences among newly consulting patients with lbp who received a pt referral and those who did not,2) examine differences between patients who participated in pt to those who did not,and 3) compare the impact of a pt referral and pt participation on lbp-related health care utilization and costs over 1 year. methods: this was a retrospective cohort study using electronic medical records and claims data. participants were 454 medicaid enrollees with new lbp consultations (mean age,40.4 years; sd = 12.0; 70% women). outcomes included advanced imaging,injections,emergency department visits,opioid prescriptions,surgery and lbp-related costs. variables associated with a pt consult,pt participation,and subsequent outcomes were evaluated with multivariate models. results: a total of 251 (55%) participants received a pt consult within 7 days of the index lbp visit and 81 (19%) participated in pt. the odds of a pt consult were increased if patients were prescribed non-steroidal anti-inflammatories (aor = 1.81; 95% confidence interval [ci],1.0 to 3.27; p = .05) or muscle relaxers (adjusted odds ratio [aor]=2.24; 95% ci,1.03 to 4.87; p=.04). whereas tobacco users and individual with multiple comorbidities were less likely to receive a pt consult (aor=0.52; 95% ci,0.20 to 0.91) and 0.42 (95% ci,0.23 to 0.78),respectively). odds of participating in pt were higher for patients receiving an radiograph at baseline (odds ratio [or]=2.63; 95% ci,1.25 to 5.53) or having multiple comorbidities (or=2.96; 95% ci,1.20 to 7.20). the odds of receiving an opioid prescription over the year following the index visit reduced with a pt consult (aor=0.65; 95% ci,0.43 to 1.00) and with pt participation (aor=0.47; 95% ci,0.24 to 0.92). no differences in lbp related costs over 1 year were noted between any of the groups. conclusions: among medicaid recipients with new-onset lbp,the index provider's prescription and imaging decisions and patient demographics were associated with pt referrals and participation. a referral to pt and subsequent pt participation was associated with reduced opioid prescriptions during follow-up. there was no difference in overall lbp-related health care costs.