Explanatory multivariate modeling for disability, pain, and claims in patients with spine pain via a physical therapy direct access model of care.

Autor: Green CE; Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA., Pastore A; Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA., Cronley L; Doctor of Physical Therapy Division, Department of Orthopaedics, Duke University, Durham, NC 27705, USA., Walker MD; Doctor of Physical Therapy Division, Department of Orthopaedics, Duke University, Durham, NC 27705, USA., Thigpen CA; ATI Physical Therapy, University of South Carolina, Greenville, SC 29681, USA.; Center for Effectiveness Research in Orthopaedics, University of South Carolina, Greenville, SC 29681, USA., Cook CE; Doctor of Physical Therapy Division, Department of Orthopaedics, Duke University, Durham, NC 27705, USA., Givens DL; Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Jazyk: angličtina
Zdroj: Journal of back and musculoskeletal rehabilitation [J Back Musculoskelet Rehabil] 2019; Vol. 32 (5), pp. 769-777.
DOI: 10.3233/BMR-171074
Abstrakt: Background: Direct access physical therapy (DAPT) may result in improved patient outcomes and reduced healthcare costs. Prognostic factors associated with spine-related outcomes and insurance claims with DAPT are needed.
Objective: To identify factors that predict variations in outcomes for spine pain and insurance claims using DAPT.
Methods: Individuals (N = 250) with spine pain were analyzed. Outcomes were classified into High, Low, or Did Not Meet minimal clinically important difference (MCID) scores. Claims were categorized into low, medium, or high tertiles. Prognostic variables were identified from patient information.
Results: Females were more likely to meet High MCID (odds ratio [OR] 2.84 (95% CI = 1.32, 6.11) and Low MCID (OR 2.86, 95% CI = 1.34, 6.10). Higher initial ODI/NDI scores were associated with High MCID (OR 1.04, 95% CI = 1.07, 1.22) and Low MCID (OR 0.91, 95% CI = 0.77, 1.07). Odds of a high claim were lowered by the absence of imaging (OR 0.04, 95% CI = 0.02, 0.09) and an active versus passive treatment (OR 0.38, 95% CI = 0.18, 0.80).
Conclusion: Females and higher initial disability predicted favorable outcomes. The novel introduction of claims into the prognostic modeling supports that active interventions and avoiding imaging may reduce claims.
Databáze: MEDLINE
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