Healthcare costs for patients with low back pain (LBP) have climbed into the billions of dollars each year. And that's the direct cost. It doesn't include the indirect cost due to loss of productivity, work-time, or wages.

It has been proposed that one way to reduce total annual costs for the care of LBP is to reduce the number of recurrences of LBP. Physiotherapy may be able to help in this matter. A previous study by these same authors showed that patients who received physiotherapy were more likely to take an active approach and have better outcomes.

Patient compliance with a physiotherapy program may improve symptoms faster. It's also possible there could be a decrease in the number of second and third bouts of low back pain experienced by the patient. And the total associated costs would most certainly go down.

To test this idea out, patients between the ages of 18 and 60 with acute low back pain were studied. Acute LBP was described as anyone with symptoms a total of less than 90 days. All were covered by an insurance company called SelectHealth.

Type of therapy administered was collected by looking at the billing codes charged for each patient during the episode of care on file. The episode of care was said to be over when the therapist didn’t see the patient for 45 days or more. Charges for care beyond 45 days up to one year were also reviewed.

Success was defined as improving at least 50 percent on the Modified Oswestry Disability Questionnaire. The test was given to each patient before and after physiotherapy care. Physiotherapy received was divided into active or passive. Active therapy included exercise and therapeutic activities. Passive was described as head/cold, electrical stimulation, ultrasound, or other similar modalities.

The number of patients who received other healthcare was also collected. This included a wide range of health care services such as a visit to an urgent care center or the emergency department, use of antiinflammatories, or the use of other medications (opioids, muscle relaxers). Chiropractic care, steroid injections, and surgery were also included.

They found that patients who completed their physiotherapy programs were less likely to use pain medication or muscle relaxers. They were also less likely to have extra imaging tests done or get a steroid injection.

Overall healthcare charges were less for those who were in physiotherapy. It appears that completing a course of physiotherapy can reduce the economic burden of low back pain. Evidence from previous studies that active methods have better long-term effects was supported by this study.

Julie M. Fritz, PhD, PT, ATC, et al. Physiotherapy For Acute Low Back Pain. July 15, 2008. Vol. 33. No. 16. Pp. 1800-1805.