Observational studySpine2017
Stagnant Physical Therapy Referral Rates Alongside Rising Opioid Prescription Rates in Patients With Low Back Pain in the United States 1997-2010.
Observational study in Spine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07285824 (Virtual McKenzie Exercises and Centralization of Pain), which is not on this map. Cited by 28 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Virtual McKenzie Exercises and Centralization of Pain: A Pilot Study
Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it, 77 citations in OpenAlex.
- Virtual Reality for Chronic Pain Management Among Historically Marginalized Populations: Systematic Review of Usability Studies.Journal of medical Internet research · 2023Pooled it
- Factors influencing referral decisions for patients with chronic low back pain: a scoping review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Review
- Prevalence of positive neural findings in patients attending outpatient physical therapy: an exploratory study.The Journal of manual & manipulative therapy · 2025Observational
- Episode of Care Characteristics Following Implementation of a No Copay Physical Therapy Program for Musculoskeletal Conditions.Physical therapy · 2025Article
- Decrease in opioid use and spinal interventions after basivertebral nerve ablation.Interventional pain medicine · 2025Article
- Article
- Racial/Ethnic and Sex Differences in Coping Mechanisms and Barriers to Health Care Among Adults with Chronic Pain: North Carolina, 2018-2019.North Carolina medical journal · 2025Article
- Patient Choice After Referral to Physical Therapy for Lower Back Pain and Knee Osteoarthritis.Archives of rehabilitation research and clinical translation · 2023Article
- Virtual McKenzie extension exercises for low back and leg pain: a prospective pilot exploratory case series.The Journal of manual & manipulative therapy · 2023Article
- Factors associated with referral to physiotherapists for adult patients consulting for musculoskeletal disorders in primary care; an ancillary study to ECOGEN.BMC primary care · 2023Article
- The relationship between capacity and utilization of nonpharmacologic therapies in the US Military Health System.BMC health services research · 2022Article
- Perceived barriers to accessing physical therapy services in Florida among individuals with low back pain.Frontiers in health services · 2022Article
- Tai Chi Quan Versus Physical Therapy on Pain and Cognitive Performance for Elderly People With Chronic Low Back Pain: Study Protocol for a Randomized Controlled Trial.Frontiers in aging neuroscience · 2022Article
- Patients' use of physical therapy for lower back pain: A qualitative study.Musculoskeletal science & practice · 2021Article
- Use of the PROMIS-10 global health in patients with chronic low back pain in outpatient physical therapy: a retrospective cohort study.Journal of patient-reported outcomes · 2021Article
- Back and neck pain: in support of routine delivery of non-pharmacologic treatments as a way to improve individual and population health.Translational research : the journal of laboratory and clinical medicine · 2021Review
- Identifying patients who access musculoskeletal physical therapy: a retrospective cohort analysis.Family practice · 2021Article
- Evaluation is treatment for low back pain.The Journal of manual & manipulative therapy · 2021Observational
- Prevalence and predictors of no-shows to physical therapy for musculoskeletal conditions.PloS one · 2021Article
- Performance of Pain Interventionalists From Different Specialties in Treating Degenerative Disk Disease-Related Low Back Pain.Archives of rehabilitation research and clinical translation · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
STUDY
designA cross-sectional observational study utilizing the National Ambulatory and National Hospital Ambulatory Medical Care Surveys between 1997 and 2010.
objectiveThe aim of this study was to characterize national physical therapy (PT) referral trends during primary care provider (PCP) visits in the United States. SUMMARY OF BACKGROUND DATA: Despite guidelines recommending PT for the initial management of low back pain (LBP), national PT referral rates remain low.
methodsRace, ethnicity, age, payer type, and PT referral rates were collected for patients aged 16 to 90 years who were visiting their PCPs. Associations among demographic variables and PT referral were determined using logistic regression.
resultsBetween 1997 and 2010, we estimated 170 million visits for LBP leading to 17.1 million PT referrals. Average proportion of PCP visits associated with PT referrals remained stable at about 10.1% [odds ratio (OR) 1.00, 95% confidence interval (95% CI) 0.96-1.04)], despite our prior finding of increasing number of visits associated with opioid prescriptions in the same timeframe.Lower PT referral rates were observed among visits by patients who were insured by Medicaid (OR 0.48, 95% CI 0.33-0.69) and Medicare (OR 0.50, 95% CI 0.35-0.72). Furthermore, visits not associated with PT referrals were more likely to be associated with opioid prescriptions (OR 1.69, 95% CI 1.22-2.35).
conclusionAlthough therapies delivered by PTs are promoted as a first-line treatment for LBP, PT referral rates remain low. There also exist disparately lower referral rates in populations with more restrictive health plans and simultaneous opioid prescription. Our findings provide a broad overview to PT prescription trend and isolate concerning associations requiring further explorations. LEVEL OF EVIDENCE: 3.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.