Clinical outcomes of early and later physical therapist services for older adults with back XXXX .

@entity1 @entity615 @entity158
BACKGROUND CONTEXT: The timing of physical therapy (PT) services and its association with later function and @entity158 are not clear, especially in older adults. PURPOSE: The purpose of this study was to compare clinical outcomes of @entity1 receiving early or later PT services with those not receiving PT among older adults presenting to primary care for a new visit for back @entity158 . STUDY DESIGN/SETTING: Prospective cohort study using the Back Pain Outcomes Using Longitudinal Data registry. @entity1 SAMPLE: A total of 3,705 adults 65 years and older with a new visit for back @entity158 were included. OUTCOME MEASURES: The outcome measures were Roland-Morris Disability Questionnaire (RMDQ), Pain Numerical Rating Scales, and EuroQol-5D. METHODS: We studied two phases of PT utilization: early (0-28 days) and later (3-6 months). At baseline, we selected the @entity1 with complete 12 months of @entity1 -reported outcomes and electronic medical record data. Early PT was defined as initiating PT less than or equal to 28 days from the index visit for back @entity158 . The no early PT group consisted of @entity1 with no PT, no injections, no surgery, and no chiropractic within 28 days. We restricted the later phase analysis to @entity1 with @entity158 greater than 2 of 10 and an RMDQ score greater than 4 to create a subsample of @entity1 with continuing clinically important back @entity158 . We defined later PT as initiating PT between 3 and 6 months after the index visit. The no later PT group consisted of @entity1 without any PT during this time. We used propensity score matching followed by multiple linear regression to estimate the mean difference in outcome. Sensitivity analysis examined clinically important change and dose of PT use among the early PT group. RESULTS: The early PT group had better functional status with an adjusted mean RMDQ of 1.1 points less than the no early PT group (95% confidence interval: -2.2, -0.1) and @entity615 of -0.5 (-0.9, -0.1) at 12 months. There was no difference between early PT groups at 3 and 6 months. The odds of a 30% improvement in function or @entity158 were not different between these matched groups at 12 months, but the early PT group had increased odds of a 50% improvement in function at 12 months (odds ratio: 1.58, 95% confidence interval: 1.04, 2.40). There was no difference between later groups at 12 months. Greater dose of PT use within the early PT group was associated with better functional status (p= .01). CONCLUSIONS: We found that among older adults presenting to their primary care providers for a new @entity615 , early referral to PT resulted in no or minimal differences in @entity158 , function, or health-related quality at 3, 6, or 12 months compared with a matched group that did not receive early PT. Secondary analysis show that @entity1 initiating early PT may be somewhat more likely to experience 50% improvement in function at 12 months.
