An Alternative Model of Care for the Treatment of Adolescent Athletes with Extension-Based Low Back Pain: A Pilot Study.
Mitchell Selhorst, Richard Rodenberg, Nick Padgett and 3 others
PMID 33604151WHAT IT FOUND
Physical therapy first model (rest and twice-weekly therapy with pain-free progression) cut advanced imaging from 8 to 1, had median billed cost 19% lower, and showed similar outcomes, but used more visits and slower return for some non-specific cases in a 16-patient pilot.
Key findings
01The PT First model of care, which used radiographs, rest from sport, twice-weekly physical therapy, and pain-free progression criteria, had 1 advanced imaging procedure versus 8 in the biomedical model.
02The median billed cost was 19% lower in the PT First model, $3885.00 versus $4774.00, while both groups made similar improvements in clinical outcomes.
03The PT First model used nearly twice as many physical therapy visits, and patients with non-specific low back pain in the biomedical model were cleared to return to sport sooner, 3.4 days versus 51 days.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a pilot with 16 patients, and the authors state it was underpowered for inferential statistics. Treatment group was chosen by the treating physician rather than random allocation, so differences between patients could have affected results. No blinding was possible for clinicians or patients. The biomedical group had slightly higher baseline pain and dysfunction, which the authors note may have biased results. The PT First model bundled radiographs, rest from sport, twice-weekly physical therapy, pain-free progression criteria, and possible later imaging or rest; the biomedical model bundled diagnosis, possible imaging, rest, bracing, and physical therapy, so the contribution of any single component cannot be separated. The study did not test clinical effectiveness against the biomedical model with inferential statistics, so it cannot show that either model caused the observed differences.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that physical therapy first is proven superior for all adolescent athletes. This was an unblinded pilot with 16 patients assigned by treating physician, and only descriptive statistics were used.