ArticleHealth services research2018
Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs.
Article in Health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 68 papers, 2 of them syntheses 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
68 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Characteristics of Early Interventions for Pain and Function Following Lower Extremity Joint Replacement: Systematic Review.Occupational therapy in health care · 2023Pooled it
- Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses.BMC health services research · 2021Pooled it
- Baseline characteristics of Veterans from improving Veteran access to integrated management of back pain (AIM-Back) - an embedded pragmatic, cluster-randomized trial in the United States.Pain management · 2026Trial
- Trial
- Trial
- More cost-effective management of patients with musculoskeletal disorders in primary care after direct triaging to physiotherapists for initial assessment compared to initial general practitioner assessment.BMC musculoskeletal disorders · 2019Trial
- The value of integrating physical therapists into primary care, including patient outcomes and health care costs: a scoping review.Physical therapy · 2026Article
- Article
- Predictive factors for care intensification in a no co-pay physical therapy model for musculoskeletal pain.BMC health services research · 2026Article
- Article
- Opioid dose, duration, and risk of use disorder in Medicaid patients with musculoskeletal pain.Pain medicine (Malden, Mass.) · 2026Article
- Episode of Care Characteristics Following Implementation of a No Copay Physical Therapy Program for Musculoskeletal Conditions.Physical therapy · 2025Article
- Trends in Nonsurgical Interventions and Analgesic Medications for Low Back Pain: A Large Claims Database Study in Japan.Pain practice : the official journal of World Institute of Pain · 2025Article
- Pain science knowledge among healthcare Professionals: A cross-sectional survey within the United States Department of Veterans Affairs.Musculoskeletal science & practice · 2025Article
- Trends and Disparities in the Use of Opioid, Gabapentinoid, and Nonpharmacologic Pain Therapies Among Medicare Beneficiaries With Acute Low Back Pain, 2016-2019.Medical care research and review : MCRR · 2025Article
- Article
- Review
- Enhancing Clinical Confidence: Effects of Medical Screening and Differential Diagnosis Training for Low Back Pain.Journal of multidisciplinary healthcare · 2025Article
- The Economic Impact of Community-Based Allied Health on the Acute Sector: A Systematic Review of Economic Evaluations.Journal of multidisciplinary healthcare · 2025Review
- Real-World Effect of a Digitally Delivered Conservative Musculoskeletal Care Program on Spinal Diagnostic Imaging Utilization in a Commercially Insured Population with Chronic Back Pain.Journal of health economics and outcomes research · 2025Article
8 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo compare differences in opioid prescription, health care utilization, and costs among patients with low back pain (LBP) who saw a physical therapist (PT) at the first point of care, at any time during the episode or not at all. DATA SOURCES: Commercial health insurance claims data, 2009-2013. STUDY
designRetrospective analyses using two-stage residual inclusion instrumental variable models to estimate rates for opioid prescriptions, imaging services, emergency department visits, hospitalization, and health care costs. DATA EXTRACTION: Patients aged 18-64 years with a new primary diagnosis of LBP, living in the northwest United States, were observed over a 1-year period. PRINCIPAL
findingsCompared to patients who saw a PT later or never, patients who saw a PT first had lower probability of having an opioid prescription (89.4 percent), any advanced imaging services (27.9 percent), and an Emergency Department visit (14.7 percent), yet 19.3 percent higher probability of hospitalization (all p < .001). These patients also had significantly lower out-of-pocket costs, and costs appeared to shift away from outpatient and pharmacy toward provider settings.
conclusionsWhen LBP patients saw a PT first, there was lower utilization of high-cost medical services as well as lower opioid use, and cost shifts reflecting the change in utilization.
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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.