According to a recent study published in the Health Services Research Journal (United States), patients who visited a physical therapist rather than a doctor at the onset of back pain symptoms had better, long term outcomes for levels of pain and mobility.
A look into insurance claims reveals that 80% of the population in the United States of America will experience back pain at some point in their lives. In 2015-2016 alone, 16% of Australians presented at the doctors with back pain.
With this in mind, researchers decided to investigate how people with back pain fared after accessing different kinds of health services. They studied the data of 150,000 insurance claims (from the USA) to measure which treatment methods were proving most effective, and physical therapy proved to be one of the most effective treatment options.
When we visit a medical practitioner, they will treat us according to the methodologies they are trained in. General Practitioners, generally speaking, are in the business of ordering tests, making diagnoses and prescribing treatments that often involve medications or lifestyle advice.
Physical therapists, which may include physiotherapists, osteopaths and similar are in the business of preventing or improving musculoskeletal conditions by training and manipulating specific muscle groups.
What is missing from most healthcare plans is communication between professionals, preventing the development of holistic treatments that allow patients to benefit from different sets of expertise simultaneously.
What the opioid epidemic in the USA tells us is that common issues, like back pain, are first treated with opioids (in the USA) by most doctors. While opioids can play an important role in recovery, if someone is only receiving medication to mask the symptoms and told to rest, their back is not getting the physical intervention it needs for regaining its former strength.
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Patients that choose physical therapy will find themselves building up muscle strength for the injured area and supporting muscle groups. They may receive massage therapy or stretching and exercise programs. They become active participants in their own healing process, and receive education around what they can do, or activities they should avoid in order to get better.
Importantly, in the American study of 150,000 insurance claims, those that visited a physical practitioner were 89% less likely to receive an opioid prescription for their back condition. They also paid less money in out of pocket costs in America’s expensive healthcare system.
The study also showed that physical therapists referred patients to hospitals at higher rates than doctors. While this fact may look alarming at first, on closer look it can be explained. People with higher needs were referred on to hospital services and specialists but were not necessarily presenting in emergency departments. The physical therapists were responsibly ensuring that individual patients received the level of care they required.
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While this was an American study, the breadth of the data has interesting take outs that can be applied in Australia too. It highlights that the way that the traditional approach to treating back pain needs to be reassessed if patients are getting the results they want and need from physical therapy, rather than from doctors administering prescriptions. The healthcare system, and individual medical practitioners, can assess if they are putting the interests of their patients first by implementing evidence based care.