Thomas R Denninger, Chad E Cook, Cole G Chapman, Timothy McHenry, Charles A Thigpen

Study Design Retrospective study. Background Alternative models of care which allow patients to choose direct access to physical therapy have shown promise in terms of cost reduction for neck and back pain. However, real-world exploration within the U.S. healthcare system is notably limited. Objectives To compare total claims paid and patient outcomes for patients with neck and back pain who chose physical therapy intervention via direct access versus from medical referral. Methods Data were accessed for care-seeking patients (n=603) between 2012-2014 with neck or back pain who chose to begin care either through traditional medical referral or direct access to a physical therapy led spine management program. All patients received a standardized pragmatic physical therapy approach with pre/post patient measures of pain and disability. Information on patient demographics and outcomes were obtained from the Medical Center Patient Registry and was combined with total claims paid calculated for the year after the index claim. Linear mixed-effects modeling was used to analyze group differences in pain/disability, visits/time, and annualized costs. Results Patients who chose to enter care via the direct access physical therapy-led spine management program displayed significantly less total costs (mean difference = $1543; 95% CI: $51 - $3028, P=.04) than those who chose traditional medical referral. Patients in both groups showed clinically important improvements in pain/disability measures, with improvements being similar for both groups (P>.05). Conclusions The initial patient choice to begin care with a physical therapist for back or neck pain resulted in lower cost of care over the next year while resulting in similar improvement in patient outcomes upon discharge from physical therapy. Our data add to emerging literature suggesting that patients' choice to access physical therapy through direct access may be associated with lower health care expenditures for patients with neck and back pain. Level of Evidence Economic and decision analyses, level 4. J Orthop Sports Phys Ther, Epub 26 Oct 2017. doi:10.2519/jospt.2018.7423.