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A value proposition for early physical therapist management of neck pain

Title: A Value Proposition For Early Physical Therapist Management Of Neck Pain: A Retrospective Cohort Analysis.
Name(s): Horn, Maggie E., author
Brennan, Gerard P., author
George, Steven Z., author
Harman, Jeffrey S., author
Bishop, Mark D., author
Type of Resource: text
Genre: Text
Date Issued: 2016-07-12
Physical Form: computer
online resource
Extent: 1 online resource
Language(s): English
Abstract/Description: 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.
Identifier: FSU_libsubv1_wos_000379459400004 (IID), 10.1186/s12913-016-1504-5 (DOI)
Keywords: disability, disability-index, Efficiency, general-population, guideline, health-care costs, joint decade 2000-2010, low-back-pain, Neck pain, numeric pain, Pain, prognostic-factors, psychometric properties, rating-scale, Value
Publication Note: The publisher’s version of record is available at
Persistent Link to This Record:
Owner Institution: FSU
Is Part Of: Bmc Health Services Research.
Issue: vol. 16

Choose the citation style.
Horn, M. E., Brennan, G. P., George, S. Z., Harman, J. S., & Bishop, M. D. (2016). A Value Proposition For Early Physical Therapist Management Of Neck Pain: A Retrospective Cohort Analysis. Bmc Health Services Research. Retrieved from