RESEARCH ARTICLE Open Access
Prediction of healthcare utilization
following an episode of physical therapy
for musculoskeletal pain
Trevor A. Lentz 1* , Jason M. Beneciuk 2,3 and Steven Z. George 4
Abstract
Background: In the United States, value-based purchasing has crea ted the need for healthcare s ystems to prospectively
identify patients at risk for high healthc are utilization beyond a physical therapy episode for musculoskeletal pain. The
purpose of this study was to determine predictors of pain-related healthcare utilization subsequent to an index episode
of physical therapy for musculoskeletal pain.
Methods:This study assessed data from the Optimal Screening for Prediction of Referral and Outcome (OSPRO)
longitudinal cohort study that recruited individuals wit h a primary complaint of neck, low back, knee or shoulder
pain in physical therapy ( n = 440). Demographics, health-related infor mation, review of systems, comorbidity and
pain-related psychological distress measures were collected at baseline evaluation. Baseline to 4-week changes in
pain intensity, disability, and pain-related psychological distress were measured as treatment response variables.
At 6-months and 1-year after baseline evaluation, individuals reported use of opioids, injection, surgery, diagnostic tests
or imaging, and emergency room visits for their pain condition over the follow-up period. Separate prediction models
were developed for any subsequent care and service-specific utilization.
Results: Subsequent pain-related healthcare utilization was reported by 43% (n = 106) of the study sample that completed
the 12-month follow-up (n = 246). Baseline disability and 4-week change in pain intensity were important global predictors
of subsequent healthcare utilization. Age, insurance status, comorbidity burden, baseline pain, and 4-week changes in pain
intensity, disability and pain-related psychological distress predicted specific service utilization.
Conclusion:In those completing follow up measures, risk of additional pain-related healthcare utilization after physical
therapy was best predicted by baseline characteristics and 4-week treatment response variablesfor pain intensity, disability
and pain-related psychologicaldistress. These findings suggest treatment monitoring of specific response variables could
enhance identification of those at risk for future healthcare utilization in addition to baseline assessment. Further study is
required to determine how specific characteristics of the clinical encounter influence future utilization.
Keywords:Screening, Psychological distress, Multimorbidity, Value, Treatment monitoring
Background
Musculoskeletal pain is a prevalent and costly health
condition with far-reaching public health consequences
including chronic pain, disability and opioid-related ad-
diction [ 1]. Clinical practice guidelines now recom-
mend non-pharmacological treatment as frontline
management for musculoskeletal pain, which will lead
to increased utilization of services such as physical
therapy [ 1– 3]. Physical therapy is effective for improving
disability and reducing costs associated with many muscu-
loskeletal pain conditions [ 4– 9]. However, pain-related
healthcare utilization beyond the physical therapy episode
(e.g. subsequent use of surgery, injection, opioids, etc.)
may indicate suboptimal treatment response, the presence
of more complex needs, or unwarranted escalation of care.
Downstream healthcare utilization is not often considered
as an outcome of care or indication of treatment effective-
ness for musculoskeletal pain. But the importance of
* Correspondence: trevor.lentz@duke.edu
1Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham,
NC 27705, USA
Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0