PMID- 27405318
OWN - NLM
STAT- MEDLINE
DCOM- 20171017
LR  - 20181202
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 16
DP  - 2016 Jul 12
TI  - A value proposition for early physical therapist management of neck pain: a 
      retrospective cohort analysis.
PG  - 253
LID - 10.1186/s12913-016-1504-5 [doi]
LID - 253
AB  - BACKGROUND: Neck pain is one of the most common reasons for entry into the 
      healthcare system. Recent increases in healthcare utilization and medical costs 
      have not correlated with improvements in health. Therefore there is a need to 
      identify management strategies for neck pain that are effective for the patient, 
      cost efficient for the payer and provided at the optimal time during an episode 
      of neck pain. METHODS: One thousand five hundred thirty-one patients who 
      underwent physical therapist management with a primary complaint of non-specific 
      neck pain from January 1, 2008 to December 31, 2012 were identified from the 
      Rehabilitation Outcomes Management System (ROMS) database at Intermountain 
      Healthcare. Patients reporting duration of symptoms less than 4 weeks were 
      designated as undergoing "early" management and patients with duration of 
      symptoms greater than 4 weeks were designated as receiving "delayed" management. 
      These groups were compared using binary logistic regression to examine odds of 
      achieving Minimal Clinically Important Difference (MCID) on the Neck Disability 
      Index (NDI) and Numerical Pain Rating Scale (NPRS). Separate generalized linear 
      modeling examined the effect of timing of physical therapist management on the 
      metrics of value and efficiency. RESULTS: Patients who received early physical 
      therapist management had increased odds of achieving MCID on the NDI (aOR = 2.01, 
      95 % CI 1.57, 2.56) and MCID on the NPRS (aOR = 1.82, 95 % CI 1.42, 2.38), when 
      compared to patients receiving delayed management. Patients who received early 
      management demonstrated the greatest value in decreasing disability with a 2.27 
      percentage point change in NDI score per 100 dollars, best value in decreasing 
      pain with a 0.38 point change on the NPRS per 100 dollars. Finally, patients 
      receiving early management were managed more efficiently with a 3.44 percentage 
      point change in NDI score per visit and 0.57 point change in NPRS score per 
      visit. CONCLUSIONS: These findings suggest that healthcare systems that provide 
      pathways for patients to receive early physical therapist management of neck pain 
      may realize improved patient outcomes, greater value and higher efficiency in 
      decreasing disability and pain compared to delayed management. Further research 
      is needed to confirm this assertion.
FAU - Horn, Maggie E
AU  - Horn ME
AD  - Department of Rehabilitation Sciences, University of Oklahoma Health Sciences 
      Center, 1200 N Stonewall Ave, Oklahoma, OK, 73117, USA. Maggie-horn@ouhsc.edu.
FAU - Brennan, Gerard P
AU  - Brennan GP
AD  - Director of Clinical Quality and Outcomes Research, Intermountain Healthcare, 389 
      South 900 East, Salt Lake, UT, 84102, USA.
FAU - George, Steven Z
AU  - George SZ
AD  - Department of Physical Therapy, University of Florida, UFHSC, Box 100154, 
      Gainesville, FL, 32610, USA.
FAU - Harman, Jeffrey S
AU  - Harman JS
AD  - Department of Behavioral Science and Social Medicine, Florida State University 
      College of Medicine, 1115 West Call Street, Tallahassee, FL, 32606, USA.
FAU - Bishop, Mark D
AU  - Bishop MD
AD  - Department of Physical Therapy, University of Florida, UFHSC, Box 100154, 
      Gainesville, FL, 32610, USA.
LA  - eng
PT  - Journal Article
DEP - 20160712
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
SB  - IM
MH  - Adult
MH  - Aged
MH  - Disability Evaluation
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neck Pain/*therapy
MH  - Pain Measurement
MH  - *Physical Therapists
MH  - Retrospective Studies
MH  - Treatment Outcome
PMC - PMC4942887
OTO - NOTNLM
OT  - Disability
OT  - Efficiency
OT  - Neck pain
OT  - Pain
OT  - Value
EDAT- 2016/07/14 06:00
MHDA- 2017/10/19 06:00
PMCR- 2016/07/12
CRDT- 2016/07/14 06:00
PHST- 2015/07/22 00:00 [received]
PHST- 2016/07/03 00:00 [accepted]
PHST- 2016/07/14 06:00 [entrez]
PHST- 2016/07/14 06:00 [pubmed]
PHST- 2017/10/19 06:00 [medline]
PHST- 2016/07/12 00:00 [pmc-release]
AID - 10.1186/s12913-016-1504-5 [pii]
AID - 1504 [pii]
AID - 10.1186/s12913-016-1504-5 [doi]
PST - epublish
SO  - BMC Health Serv Res. 2016 Jul 12;16:253. doi: 10.1186/s12913-016-1504-5.