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; Claire E Ashton-James; Ana Helena Salles dos Reis; Yanyu Chen; Manuela Ferreira; Paulo Ferreira

doi:10.1093/ptj/pzac150

Table 4B

Continued from Table 4A

Category	Study	Health Care Outcomes per Episode of Care
Health care procedures and hospitalizations	Frogner et al³⁰ (2018)	Patients who had physical therapy first had 38.3% (SE = 5.2%; P < .001) reduced probability of ED visits but 19.3% (SE = 3.0%; P < .001) increased probability of hospitalization
	Fritz et al²⁴ (2015)	Physical therapy as initial management not associated with statistically significant difference in odds of receiving an injection (OR = 0.36 [95% CI = 0.04 to 2.99]; P = .35) or having ED visit (OR = 0.46 [95% CI = 0.18 to 1.18]; P = .11) compared with primary care; no patients who initiated care via physical therapy had surgery
	Fritz et al²⁵ (2016)	Care initiated via physical therapy (OR = 0.36 [95% CI = 0.05 to 2.82]) and chiropractic (OR = 0.42 [95% CI = 0.10 to 1.80]) had no significant effect on ED care or odds of injection compared with care initiated via primary care; care initiated via chiropractor had reduced odds (OR = 0.13 [95% CI = 0.03 to 0.53]) of spinal surgeon consultation; no patients who initiated care via physical therapy had surgery

Patient outcomes	Carey et al²³ (1995)	No clinically significant differences in time to functional recovery (patient reported) measured among different initial provider entry points; patient satisfaction levels for initiation of care with chiropractor vs PCP or orthopedic or HMO provider were: information given (47.1% vs 30.2%; P < .001), treatment of back problem (52.1% vs 31.5%; P < .001), outcomes (42.1% vs 26.5%; P < .001), detailed history of back pain (88.4% vs 68.4%; P < .001), careful examination of back (96.1% vs 79.9%; P < .001), and cause of problem clearly explained (93.6% vs 74.6%; P < .001)
	Henschke et al²⁸ (2013)	No statistically significant differences in satisfaction with care (OR = 0.81 [95% CI = 0.58 to 1.12]; P = .2) or satisfaction with symptoms (OR = 0.98 [95% CI = 0.73 to 1.33]; P = .916) between care initiated via PCP and that initiated via physical therapist

^aDC = chiropractor; ED = emergency department; HCP = health care practitioner; HMO = health maintenance organization; HR = hazard ratio; IQR = interquartile range; LBP = low back pain; OR = odds ratio; PCP = primary care physician.