Influence of Initial Health Care Provider on Subsequent Health Care Utilization for Patients With a New Onset of Low Back Pain: A Scoping Review.
James Zouch, Josielli Comachio, André Bussières and 5 others
PMID 36317766WHAT IT FOUND
Starting new low back pain care with a physical therapist or chiropractor was linked to fewer opioid prescriptions and less imaging than starting with a doctor.
However, costs varied, and no study proved these providers improved patient recovery or satisfaction.
Key findings
01Initiating care with nonmedical providers like physical therapists or chiropractors was consistently associated with reduced short-term and long-term opioid prescriptions compared with medical providers.
02Physical therapy as an entry point was associated with lower odds of plain radiography, while chiropractic care was associated with lower odds of advanced imaging compared to primary care physicians.
03There was no evidence of a difference in patient outcomes such as functional recovery or satisfaction when comparing nonmedical initial providers to medical providers.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
All included studies were observational; no randomized controlled trials were found. This means we cannot prove that the provider type *caused* the differences in care, as patient selection bias (e.g., healthier or wealthier patients choosing direct access) is a major confounder. The term "nonmedical provider" lumps together very different professions (e.g., physical therapists, chiropractors, nurse practitioners) with different scopes of practice and training, which may mask specific effects. Most studies were conducted in the United States, limiting generalizability to countries with different health care systems and direct access laws. Key patient variables like pain severity and disability were not measured in most studies, so it is unclear if patients who saw nonmedical providers were simply less sick. Cost findings were inconsistent across studies.
Declared interests
No specific funding sources or conflicts of interest were declared in the provided text.
The easy way to misread this
Do not interpret these findings as proof that nonmedical providers deliver better clinical outcomes. The studies showed differences in *utilization* (prescriptions and imaging), not in *recovery* or *satisfaction*. Furthermore, because the studies were observational, the lower opioid rates may reflect patient self-selection or prescribing laws rather than the superior care quality of the nonmedical provider.