Early access to Physical Therapy services (direct access) has been previously shown to reduce a patient’s cost of care by up to $1500. In addition to its’ cost savings, direct access to Physical Therapy treatment has been shown to be a safe and effective short and long term treatment plan for patients with musculoskeletal pain. The greatest impact of this management model has been shown in patients with low back pain who face more costly and invasive treatment options including injections, imaging, surgery, and medications if they see a Physical Therapist later rather than sooner in their care. The dangers of these medications, in particular opiate pain medication, has come to the forefront in our country as a health crisis. A recent study highlights the impact direct access to Physical Therapy services can have on medication use in patients with low back pain.
Kazis and colleagues published a retrospective analysis of patients with low back pain to determine the impact early Physical Therapy on opiate medication use (BMJ open. 2019). Authors analyzed more than 200,000 patients to determine their health care utilization following an episode of low back pain. About half of all patients saw a primary care physician first (53%) and the others were seen by a conservative care provider including Physical Therapists. Patients who saw a PT first had a 85% and 74% decreased risk of receiving an opioid in the first 30 days and first year of their care, respectively. As expected, in states without direct access restrictions, such as Colorado, the impact was greater than more restrictive states. The authors concluded, “early engagement of conservative therapists may decrease initial opioid prescriptions in association with MD visits by providing the opportunity to incorporate evidence-based non pharmaceutical interventions”.