Explanatory multivariate modeling for disability,pain,and claims in patients with spine pain via a physical therapy direct access model of care

Abstract

BACKGROUND:

Direct access physical therapy (DAPT) may result in improved patient outcomes and reduced healthcare costs. Prognostic factors associated with spine-related outcomes and insurance claims with DAPT are needed.

OBJECTIVE:

To identify factors that predict variations in outcomes for spine pain and insurance claims using DAPT.

METHODS:

Individuals (N $=$ 250) with spine pain were analyzed. Outcomes were classified into High, Low, or Did Not Meet minimal clinically important difference (MCID) scores. Claims were categorized into low, medium, or high tertiles. Prognostic variables were identified from patient information.

RESULTS:

Females were more likely to meet High MCID (odds ratio [OR] 2.84 (95% CI $=$ 1.32, 6.11) and Low MCID (OR 2.86, 95% CI $=$ 1.34, 6.10). Higher initial ODI/NDI scores were associated with High MCID (OR 1.04, 95% CI $=$ 1.07, 1.22) and Low MCID (OR 0.91, 95% CI $=$ 0.77, 1.07). Odds of a high claim were lowered by the absence of imaging (OR 0.04, 95% CI $=$ 0.02, 0.09) and an active versus passive treatment (OR 0.38, 95% CI $=$ 0.18, 0.80).

CONCLUSION:

Females and higher initial disability predicted favorable outcomes. The novel introduction of claims into the prognostic modeling supports that active interventions and avoiding imaging may reduce claims.