The Influence of Active, Passive, and Manual Therapy Interventions for Low Back Pain on Opioid Prescription and Health Care Utilization

Abstract

Abstract Objective The aim of this study was to explore associations between the utilization of active, passive, and manual therapy interventions for low back pain with one-year escalation-of-care events including opioid prescriptions, spinal injections, specialty care visits, and hospitalizations. Methods This was a retrospective cohort study of 4827 patients identified via the Military Health System Data Repository who received physical therapist care for low back pain in 4 outpatient clinics between January 1, 2015 and January 1, 2018. One-year escalation-of-care events were evaluated based on type of physical therapist interventions (ie, active, passive, or manual therapy) received using adjusted odds ratios. Results Most patients (89.9%) received active interventions. Patients with 10% higher proportion of visits that included at least 1 passive intervention had a 3% to 6% higher likelihood of one-year escalation-of-care events. Similarly, with 10% higher proportion of passive to active interventions used during the course of care, there was a 5% to 11% higher likelihood of one-year escalation-of-care events. When compared to patients who received active interventions only, the likelihood of incurring one-year escalation-of-care events were 50 to 220% higher for those who received mechanical traction and 2 or more different passive interventions, but lower by 50% for patients who received manual therapy. Conclusion Greater use of passive interventions for low back pain was associated with elevated odds of one-year escalation-of-care events. In addition, the use of specific passive interventions such as mechanical traction in conjunction with active interventions resulted in suboptimal escalation-of-care events, while the use of manual therapy was associated with more favorable downstream health care outcomes. Impact Physical therapists should be judicious in use of passive interventions for management of low back pain as they are associated with greater likelihood of receiving opioid prescriptions, spinal injections, and specialty care visits.