Initial treatment approaches and healthcare utilization among veterans with low back pain: a propensity score analysis

Catherine Schmidt; Matthew Borgia; Tingting Zhang; Perman Gochyyev; Theresa I Shireman; Linda Resnik

doi:10.1186/s12913-023-09207-y

Initial treatment approaches and healthcare utilization among veterans with low back pain: a propensity score analysis

BMC Health Serv Res. 2023 Mar 21;23(1):275. doi: 10.1186/s12913-023-09207-y.

Authors

Catherine Schmidt^{1

2

3}, Matthew Borgia⁴, Tingting Zhang⁵, Perman Gochyyev⁶, Theresa I Shireman⁵, Linda Resnik^{4

5}

Affiliations

¹ Department of Physical Therapy, MGH Institute of Health Professions, 36 1st Avenue, Boston, MA, 02129-4557, USA. [email protected].
² Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI, 02912, USA. [email protected].
³ Department of Health Services, Policy and Practice: Center for Gerontology and Health Care Research, Brown University, Providence, RI, 02912, USA. [email protected].
⁴ Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI, 02912, USA.
⁵ Department of Health Services, Policy and Practice: Center for Gerontology and Health Care Research, Brown University, Providence, RI, 02912, USA.
⁶ Department of Physical Therapy, MGH Institute of Health Professions, 36 1st Avenue, Boston, MA, 02129-4557, USA.

Abstract

Background: Opioid prescriptions for Veterans with low back pain (LBP) persist despite the availability of PT, a lower medical risk treatment option. Patterns of treatment and subsequent healthcare utilization for Veterans with LBP are unknown. The purpose of this study was to evaluate the association of physical therapy (PT) and opioids and outcomes of spinal surgery and chronic opioid use for Veterans with incident LBP.

Methods: We conducted a retrospective cohort study identifying Veterans with a new diagnosis of LBP using ICD codes from the Veterans Administration national database from 2012 to 2017. Veterans were classified into three treatment groups based on the first treatment received within 30 days of incident LBP: receipt of PT, opioids, or neither PT nor opioids. Outcomes, events of spinal surgery and chronic opioid use, were identified beginning on day 31 up to one year following initial treatment. We used propensity score matching to account for the potential selection bias in evaluating the associations between initial treatment and outcomes.

Results: There were 373,717 incident cases of LBP between 2012 and 2017. Of those 28,850 (7.7%) received PT, 48,978 (13.1%) received opioids, and 295,889 (79.2%) received neither PT or opioids. Pain, marital status and the presence of cardiovascular, pulmonary, or metabolic chronic conditions had the strongest statistically significant differences between treatment groups. Veterans receiving opioids compared to no treatment had higher odds of having a spinal surgery (2.04, 99% CI: 1.67, 2.49) and progressing to chronic opioid use (11.8, 99% CI: 11.3, 12.3). Compared to Veterans receiving PT those receiving opioids had higher odds (1.69, 99% CI: 1.21, 2.37) of having spinal surgery and progressing to chronic opioid use (17.8, 99% CI: 16.0, 19.9).

Conclusion: Initiating treatment with opioids compared to PT was associated with higher odds of spinal surgery and chronic opioid use for Veterans with incident LBP. More Veterans received opioids compared to PT as an initial treatment for incident LBP. Our findings can inform rehabilitation care practices for Veterans with incident LBP.

Keywords: Health care utilization; Low back pain; Opioids; Physical therapy; Physiotherapy; Propensity score analysis; Rehabilitation; Spinal pain; Spinal surgery.

MeSH terms

Analgesics, Opioid / therapeutic use
Chronic Pain* / therapy
Humans
Low Back Pain* / epidemiology
Low Back Pain* / therapy
Opioid-Related Disorders* / drug therapy
Patient Acceptance of Health Care
Propensity Score
Retrospective Studies
Veterans*

Substances

Analgesics, Opioid

Grants and funding

IK6 RX003097/RX/RRD VA/United States