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Primary Care Research

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Varied use of physical therapists by people with back and neck pain suggests overuse by some patients and underuse by others

A study of people with back or neck pain being seen for initial evaluation at 21 U.S. spine centers found great variation in their use of physical therapists. Although physical therapist use was associated with measures of illness severity (for example, duration of the problem and previous history of surgery), factors other than clinical need were the strongest predictors of use. For instance, men and older patients were less likely to use a physical therapist. Individuals with a college education were 10 percent more likely than those with a high school education to use a physical therapist.

For this study, supported in part by the Agency for Healthcare Research and Quality (HS00032), researchers analyzed data from the National Spine Network database and patient and physician survey responses to examine factors associated with physical therapist use among 29,049 people who had back pain or neck pain or both over a 5-year period (1998 to 2002). People who had workers' compensation coverage or who had taken legal action for an injury were 43 percent and 31 percent more likely, respectively, to use a physical therapist. Also, physical therapist use was 16 percent lower in the Midwest and 27 percent lower in the South than in the Northeast.

These findings suggest that people suffering from back or neck pain who might benefit from physical therapy may not be receiving it, or that those who would not benefit from physical therapy are receiving it, or both.

More details are in "Management of back and neck pain: Who seeks care from physical therapists?" by Janet K. Freburger, P.T., Ph.D., Timothy S. Carey, M.D., M.P.H., and George M. Holmes, Ph.D., in the September 2005 Physical Therapy 85(9), pp. 872-886.

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