Xinliang “Albert” Liu, PhD, Assistant Professor in the Department of Health Management and Informatics at the University of Central Florida talks about the effects of choosing physical therapy to help with back pain verses opioids.
Interview conducted by Ivanhoe Broadcast News in September 2018.
What led to your interest on this most recent study on back pain with a focus on cost?
Dr. Liu: We chose to study low back pain because it is very common and a very costly condition. About thirty percent of adults in the United States reported having low back pain in the past three months that lasts a whole day or more. Also, the total cost associated with low back pain exceeds one hundred billion dollars in the United States alone. And, low back pain is also the leading cause of disability in the United States and around the globe.
Tell me what you did. How did you look at the numbers?
Dr. Liu: So in our study, we tried to use real-world data to look at the impact of the timing of physical therapy initiation and the overall healthcare utilization and cost. What we did was to generate a large database with insurance claims from New York State. There are about twenty million people living in New York State and in our database we included eleven percent of the population there. So, we identified ninety eight thousand people with low back pain over a five year period. Then, we identified patients with acute low back pain. So in the end, we included forty six thousand nine hundred and fourteen patients with acute low back pain in our analysis. Among these patients we identified six thousand and six hundred and sixty eight patients who received physical therapy. And then we looked how their outcomes based on the timing of physical therapy initiation.
When you’re talking about timing, was there a window in particular that you were interested in? Tell me what you found.
Dr. Liu: We started with the initial patients who received diagnosis of low back pain. Then, we looked at whether they received physical therapy within ninety days. We divided patients in to different cohorts with the timing of physical therapy initiation. We divided them in to who started the physical therapy within three days, between four and fourteen days, fifteen and twenty eight days, twenty nine to ninety days.
What did you find?
Dr. Liu: We found that the group of patients who started the physical therapy within three days used the least healthcare services and incurred lower cost.
What did that translate out to in terms of cost savings?
Dr. Liu: We found that for patients who started the physical therapy within three days, were ten to fifteen percent less likely to use a pain medication over one year compared with the patient who started physical therapy at later times.
What else did you find?
Dr. Liu: We found that compared with the patients who started physical therapy at later times, patients who started the physical therapy within three days incurred between two hundred and three thousand or four hundred dollars lower low back pain related costs.
That’s significant. Were you surprised by those findings, by those numbers?
Dr. Liu: A little bit surprised to see the cost savings. We did a quick bank of the analysis for those who were referred to physical therapy if they can all start physical therapy within three days. We can achieve a cost saving of seven billion dollars nationwide and four hundred thirteen million dollars in New York State alone.
What kind of a message would that send to policy makers and law makers when you look at this potential for cost savings?
Dr. Liu: With this study and several previous studies, we are pretty comfortable to say of all patients who were referred to physical therapy, they should start physical therapy as early as possible.
Can you tell me a little bit about the importance of bridging that gap
Dr. Liu: The health care industry is collecting tons of data every day. Nowadays every hospital is sitting on a gold mine of big data. But big data is lengthy access. Big data cannot speak for itself. To unleash the potential of big data, we need to create opportunities for subject matter experts like clinicians and data scientists to work together. With all three elements: big data, subject matter experts and data scientists, we can create a lot of actionable incites.
Is there anything I didn’t ask you that you would want to make sure people know about this research that you and your colleagues are doing?
Dr. Liu: As a final note, I want to mention there is a same day physical therapy. The spine clinic at Virginia Mason Medical Center in Seattle, Washington offers same day physical therapy appointments. This program was created in collaboration with a lot of employers, so if we can get the financial incentive right we can offer physical therapy early in the treatment period and still achieve lower cost, higher patient satisfaction and less absenteeism for employees.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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