text: additional healthcare use is expected following physical 
  therapy, especially among individuals 
  that are on 
  long-term pain management pathways due to chronic or 
  persistent symptoms. Yet with over 40% reporting subse- 
  quent pain-related healthcare among those completing 
  follow-up, it is apparent that opportunities exist to im- 
  prove pathway selection and/or the effectiveness of 
  therapy for individuals with musculoskeletal 
  physical 
  pain. This finding is particularly notable given recent 
  efforts to define physical therapy as an effective first line, 
  non-pharmacological 
  treatment option against more 
  invasive or higher risk services, such as surgery or opioid 
  use, respectively. Predictive variables identified in this 
  analysis can be used to develop risk models that better 
  inform pathway selection for those seeking physical ther- 
  apy for musculoskeletal pain. The precise application of 
  these risk models, and how they inform policy and prac- 
  tice should be the target of future study. However, phys- 
  ical 
  incorporate enhanced 
  treatment monitoring to assess ongoing risk for down- 
  stream utilization, as well as physical therapist-led inter- 
  ventions 
  important 
  thoroughly 
  modifiable factors such as pain intensity, disability and 
  pain-related psychological distress [38]. Improved path- 
  way selection might entail the consideration of referral 
  to or co-treatment with other providers to more ad- 
  equately address non-modifiable characteristics. Collect- 
  ively, 
  these approaches could improve the value of 
  physical therapy by minimizing risk for high downstream 
  healthcare utilization and potentially unwarranted escal- 
  ation of care. 
  
  therapy re-design might 