Performance of Pain Interventionalists From Different Specialties in Treating Degenerative Disk Disease-Related Low Back Pain.
Weibin Shi, Edeanya Agbese, Adnan Z Solaiman and 2 others
PMID 33543087WHAT IT FOUND
Provider specialty did not predict how long patients with degenerative disk disease waited for spine surgery or what they paid for injections.
However, receiving physical therapy significantly delayed surgery. This suggests that for patients on the path to surgery, concurrent physical therapy is associated with a longer period of non-surgical management.
Key findings
01There were no significant differences in the cost of interventional treatments or the time from diagnosis to surgery among the six provider specialties studied (anesthesiology, neurosurgery, orthopedics, pain management, physiatry, and radiology).
02Receiving physical therapy was independently associated with a significantly delayed time to spinal surgery (Hazard Ratio 0.77; 95% CI 0.62-0.96).
03Patients with radiculopathy received significantly more interventional treatments before surgery than those without radiculopathy (4.87 vs 3.38; P <.0001).
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study used private insurance claims data, so results may not generalize to Medicare, Medicaid, or uninsured populations. The data did not quantify the number or duration of conservative treatments patients received before surgery. The study could not distinguish between therapeutic epidural steroid injections and diagnostic nerve root blocks due to shared billing codes. The analysis only included patients who received interventional treatments from a single provider specialty, which may not reflect typical multidisciplinary care.
Declared interests
The authors declared no relevant conflicts of interest. The study used the Truven Health MarketScan Commercial Claims and Encounters Database.
The easy way to misread this
Do not interpret the association between physical therapy and delayed surgery as proof that PT prevents surgery. This is an observational study of claims data, which cannot account for why patients chose PT or their baseline severity. The delay in surgery could also reflect insurance barriers or patient preference rather than clinical improvement.