Dec 7, 2021 | Insights
Assessing injured workers quickly, starting physical therapy (PT) early and when appropriate, getting them manual therapy (MT) quickly will lead to better outcomes for injured workers.
Researchers have found that there are big benefits to starting PT early. In fact, fewer diagnostic tests, opioid prescriptions, pain management injections and lumbar surgeries ultimately lead to faster return to work and lower total medical costs of claims. This begs the question: Is there a specific PT treatment that further influences the utilization and costs of medical resources and outcomes?
All eyes are on MT, a hands-on therapy that improves range of motion and reduces pain. Many practitioners and managed care professionals have long believed that early MT could improve outcomes.
To help fill information gaps in medical and healthcare policy research regarding MT, the Workers Compensation Research Institute (WCRI) analyzed low back pain (LBP) claims in 28 states that did not have surgery and received MT. WCRI compared costs and outcomes between claims with early MT (within 14 days of the worker starting PT) and late MT, as well as claims with and without MT.
Researchers including a member of MedRisk’s International Scientific Advisory Board, Kathryn Mueller, MD, found that early MT was associated with lower utilization of medical services, lower medical and indemnity payments, and shorter temporary disability duration. In fact, the average medical cost per claim was 27 percent lower, the average indemnity payment was 28 percent lower and temporary disability duration was 22 percent shorter when workers received early MT compared with those receiving it later.
While this is the first of many investigations needed to assess the overall cost-effectiveness of MT, the study is a positive step towards more effective WC outcomes.
This also supports MedRisk’s PTConsult program, where a consulting therapist can help identify people who need MT and recommend they get it quickly. Through our extensive network, electronic data interfaces (EDI) and clinical expertise, we partner with clients to facilitate early PT and ensure optimal outcomes for workers.
To read the full study, click here.
Outcomes Associated with Manual Therapy for Workers with Non-Chronic Low Back Pain. Dongchun Wang, Kathryn Mueller, and Randy Lea. September 2021. WC-21-23.
Oct 5, 2021 | Insights
Communication is the heart of the relationship between a physical therapist and patient. Here are four guidelines to help improve patient conversations—and create superior outcomes.
After an initial evaluation, PTs will typically prescribe exercises and provide low back pain (LBP) patients with information about their diagnosis, prognosis and plan of care.
A positive interaction between the patient and physical therapist during this evaluation has been linked with reduced pain and disability, as well as a higher satisfaction with treatment. In fact, studies have shown that the initial evaluation process may produce small but significant therapeutic effects related to pain, fear-avoidance and functional measure of mobility and sensitivity.
But this is only true if the therapist successfully delivers the advice and the patient receives and retains the intended message.
Unfortunately, there are cases in literature that show inconsistencies between a PT’s self-assessment and a patient’s perception. This is not just a communication breakdown but a risk to the patient’s overall care.
For example, patients with spinal problems need to understand that back pain is generally benign and activity is key to recovery. If they do not perceive this message, they have a higher risk of disability and lower treatment satisfaction 6 months after treatment.
In a study published in Wiley Physiotherapy Research International, all patients remembered the PT’s first piece of advice, with diminishing retention for the second and third pieces of advice. Simultaneously, PTs underestimated success of message delivery in the first and second items of advice and overestimated success for the third.
While the disconnect may have been marginal in this study, there were a number of factors at play that enhanced the patient-therapist interaction. Based on this research, here’s what can be done to ensure PTs successfully communicate and patients actually listen.
How to Make Sure Patients Listen: Four Guidelines
#1. Use Shared Decision Making
Shared decision making is a consultation process in which a clinician and patient work together to make a health decision. It involves discussing options, benefits and harms and considering patient values, preferences and circumstances.
Taking a collaborative approach of the clinical evaluation and involving patients throughout the diagnostic process helps ensure that the patient understands what the provider recommends—thus bolstering retention of advice and exercises.
#2. Prescribe Simple Exercises
It’s one thing to retain a provider’s advice for managing LBP. It’s another to actually follow it.
Patients are more likely to participate in exercise programs that consider their preferences, circumstances and past exercise experiences. With that said, patient adherence improves when providers prescribe:
- A limited number of exercises
- Simple yet effective exercises
- Exercises that are easy to include in daily life
#3. Address Patient Concerns
A patient’s worries, fear-avoidance, individual beliefs and experiences with LBP can negatively impact their prognosis and overall treatment outcomes.
For example, a patient may be influenced by a family member’s experience with similar pain.
It’s important to have a dialogue about these concerns and then develop specific and reasonable management strategies that addresses a patient’s worries.
#4. Identify & Address Patient Expectations
Finally, patients come into physical therapy with a set of expectations.
For the most part, patients expect specific, tailored exercises. They also expect investigations that lead to a diagnosis and an explanation of what actually caused it.
Opening a dialogue about these expectations—and addressing them—will further improve communication and patient outcomes.
Conclusion
Patient-therapist communication is critical and it all starts at the initial evaluation. As the industry continues to prioritize patient-centric care, it’s important to engage the patient from the beginning to ensure that they hear and understand the diagnosis and treatment.
Because when patients remember what PTs tell them, they are more likely to adhere to exercises and see improvements with their LBP.
MedRisk’s patient-centric approach to managed physical medicine starts with its PT Consult service: a consultation between an on-staff PT and the patient in advance of treatment. PT Consult prepares patients for what PT is like and the physical benefits it brings, such as strength, pain relief, mobility and recovery. There is a screening for any psychosocial factors that could impact recovery and the consultation helps set the patient’s expectations for therapy and what the recovery journey may look like, establishing a positive mindset as they get ready to start with their MedRisk provider.
Supp, G, Schoch, W, Baumstark, MW, May, S. Do patients with low back pain remember physiotherapists’ advice? A mixed-methods study on patient-therapist communication. Physiother Res Int. 2020; 25:e1868.
https://doi.org/10.1002/pri.1868
Sep 9, 2021 | Insights
For patients with a new episode of neck pain, initially consulting with a nonpharmacological provider (physical therapist or chiropractor) may decrease opioid exposure.
Neck pain is an immense physical, social and economic burden, regarded as a major public health problem. In fact, half of all individuals will experience a clinically important episode of neck pain at some point in their life, and 80% of those people eventually seek care. Despite this prevalence, there has been no consensus on the type of provider a patient should see first for care—a key indicator of downstream healthcare utilization. On top of that, there are the ever-present dangers of opioid addiction, which has been identified as a public health epidemic.
To address these problems, a study published in the Mayo Clinic Proceedings: Innovations, Quality & Outcomes journal aimed to determine the connection between the type of provider initially consulted and 1-year, downstream healthcare utilization to inform future care recommendations.
In the study, Horn et al investigated a retrospective cohort of 1,702 patients with a new episode of neck pain over a 1-year period. The researchers then separated those patients into groups based on who they consulted first: primary care provider (PCP), physical therapist (PT), chiropractor (DC), or a specialist.
The study found that the practitioner consulted at the index visit for neck pain can have an impact on downstream healthcare utilization. More importantly, the researchers found that, when compared to an initial neck pain consultation with a PCP, an initial consultation with a nonpharmacological provider (DC or PT) is associated with a decrease in opioid use 30 days and 1 year after initial consultation.
These findings are consistent with recent guidelines, which favor nonpharmacological interventions. In light of the opioid addiction epidemic, stronger alignment of PTs and DCs as front-line providers by healthcare systems may be needed.
MedRisk’s PTConsult services support this goal by proactively identifying and solving for issues through a telephone consultation and screening process. PTConsult takes or recommends the best course of action to eliminate obstacles to recovery and reduce total claim cost and healthcare utilization.
To read the full article, click here.
Horn ME, George SZ, and Fritz JM – Influence of Initial Provider on Health Care Utilization in Patients Seeking Care for Neck Pain
Mayo Clin Proc Innov Qual Outcomes. 2017 Dec; 1(3): 226–233.
Sep 3, 2021 | Insights
Physical therapists can empower patients with chronic musculoskeletal disorders by supporting effective self-management.
Persistent musculoskeletal disorders—including spine-related neck and back problems—are painful to patients and costly for workers’ compensation payers and society as a whole. Among occupationally active adults, musculoskeletal disorders are the main causes of disability. Often work related, they can lead to lost time and reduced productivity.
Biomechanical and psychosocial risk factors often influence musculoskeletal disorders. That’s why, as an article published in the Journal of Orthopaedic & Sports Physical Therapy argues, a person-centered approach focusing on self-management strategies is so essential to helping patients restore and maintain function.
In the paper, Barlow et al outline the physical therapist’s (PT) role in supporting effective self-management. The authors define self-management as “the ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition.”
As experts in musculoskeletal disorders, PTs are ideally positioned to provide self-management support that focuses on teaching skills that patients can use to manage these conditions on their own. In this approach, PTs help patients understand their conditions and the biomechanics of them while promoting behavioral changes and active lifestyles.
PTs help patients develop a patient-preferred approach to physical therapy exercises to improve function and strength, reduce pain, and increase well-being. The goal is for the patients to develop their own strategies to reducing their symptoms. Techniques may involve exercise, pain management, cognitive behavioral therapy, shared decision-making, acceptance, problem-solving and/or mindfulness, and other techniques. It’s all very individualized.
With self-management, PTs provide support as the patients set goals, recognize barriers to achieving them and learn how to measure the effectiveness of their own self-management. This provider-patient partnership is an essential component of this approach.
As the leading provider of managed physical medicine for the workers’ compensation industry, MedRisk stays abreast of industry trends such as this. By so doing, we continue providing our carriers, TPAs and employers access to the best national network of credentialed PTs in the workers’ compensation industry.
To read the full article, click here.
Promoting the Use of Self-management Strategies for People with Persistent Musculoskeletal Disorders: The Role of Physical Therapists
Nathan Hutting, Vernerian Johnston, J. Bart Steal, and Yvonne F. Hearkens
Journal of Orthopaedic & Sports Physical Therapy 2019 49:4, 212-215
Aug 4, 2021 | Insights
Adherence to established clinical practice guidelines could reduce high downstream healthcare utilization.
Musculoskeletal pain as a whole is a common and costly health condition. Up to 84% of the general population will report at least one episode of low back pain (LBP) at some point in their life. This high rate of LBP treatment also has high downstream costs. An article published in PLOS One systematically reviews a collection of peer reviewed studies to evaluate the influence of physical therapy guideline adherence on healthcare utilization and costs for LBP patients.
Hanney et al conducted an electronic search across various peer-reviewed journals to assess current evidence on how guideline adherence affects LBP costs. The authors identified seven primary factors for healthcare utilization and costs:
- Number and duration of PT visits
- Prescription medication use
- Physician office visits
- Emergency department care
- Advanced imaging
- Surgical procedures
- Injection procedures
With some exceptions, the review showed that those participating in an adherent PT treatment program experience lower healthcare utilization. This includes fewer and shorter PT visits, fewer medications, fewer visits to the physicians or emergency department and less use of advanced imaging, surgical, and injection procedures.
While further research is needed to provide firm evidence on the impact of guideline adherence among patients with LBP, this preliminary evidence is a great step towards optimized effectiveness and efficiency in value-based healthcare systems.
That’s why MedRisk invested in the development and on-going maintenance of physical medicine specific evidence-based treatment guidelines. These guidelines take into consideration chronicity (the age of the injury), complexity (multiple body parts and/or comorbidities), severity and surgery. They also address the best treatment choice, timing, and sequence of interventions. Their specificity make them a valuable supplement to ODG, ACOEM, and state-specific guidelines. MedRisk’s proprietary guidelines, developed and maintained by our International Scientific Advisory Board, allow us to proactively identify cases that may be trending off track and support clinical decision-making—ultimately eliminating unnecessary downstream utilization and costs.
To read the full article, click here.
Hanney WJ, Masaracchio M, Liu X, Kolber MJ. The Influence of Physical Therapy Guideline Adherence on Healthcare Utilization and Costs among Patients with Low Back Pain: A Systematic Review of the Literature. PLoS One. 2016 Jun 10;11(6):e0156799. doi: 10.1371/journal.pone.0156799. PMID: 27285608; PMCID: PMC4902217.
Jun 3, 2021 | Insights
Psychosocial factors—including fear of movement and anxiety about the future—are an expected and normal part of LBP experiences.
Low back pain (LBP) interventions are often categorized as “physical” or
“psychological,” creating a potential barrier to recovery in some patients who may be inhibited by these psychosocial factors. An article published in the British Journal of Sports Medicine challenges this separation, stating that understanding and addressing psychosocial factors in clinical practice can help better optimize patient management.
In the research, O’Keeffe et al investigated how psychosocial factors do not always indicate mental health disorders and are not distinct from biological factors. Reductions in pain and disability after treatment are, to some degree, facilitated by changes in non-physical factors, like self-efficacy. For example, exposure to a specific movement that the patient fears paired with an empowering narrative from the provider can reduce the associated fear or anxiety.
The study also argued that psychosocial factors do not only appear in persistent pain presentations. In fact, the authors, who included Steven Z. George, PT, PhD, FAPTA, a member of MedRisk’s International Scientific Advisory Board (ISAB), said that psychosocial factors are an expected and normal part of LBP experiences, acute or chronic.
Psychosocial factors may be just as important to consider as “other factors” when a patient “fails” during “normal” treatment. Exploring and addressing these factors at the front end will ultimately drive more successful patient outcomes. This research supports MedRisk’s PTConsult, a service that makes adjusters aware of any psychosocial factors and provides patient education on the importance of physical therapy, treatment expectations and any perceived barriers to recovery (including anxiety).
To read the full article, click here.
O’Keeffe M, George SZ, O’Sullivan PB, et al Psychosocial factors in low back pain: letting go of our misconceptions can help management. British Journal of Sports Medicine 2019;53:793-794.
