The Importance of Early Physical Therapy Intervention

Physical therapy is crucial to the prevention of and sustained recovery from a number of musculoskeletal conditions, spanning neck, back, hip, and knee pain, in addition to certain vestibular balance disorders. As the frequency of emergency department visits continues to increase, alongside an aging population, it is increasingly important to integrate physiotherapy services into patient care. However, the medical, social, and financial benefits of physical therapy depend significantly on its swift implementation early on in a patient’s health care program.

Physical therapy yields a number of well-established benefits. While reducing the utilization of strained health care resources and minimizing costs to patients and health care systems ¹, as a nonpharmacological alternative to pain reduction, it also reduces overall opioid use. One study found that Medicare beneficiaries who failed to receive clear physical therapy recommendations tended to experience increased 30-day rehospitalization rates, emergency department visits, and rates of death ². In addition, a recent prospective observational study highlighted a reduced need for resources and opioids as a result of dedicated emergency department PT ³. This was confirmed by a number of parallel studies showing that therapy interventions have been confirmed to reduce overall opioid prescriptions – of particular salience given the current opioid epidemic ⁴.

This said, however, the swift implementation of physical therapy is key to its effectiveness over the course of a patient’s recovery. Indeed, a study found that rapidly implemented physical therapy interventions – implemented as a first point of care for lower back pain – reduced the use of imaging services and emergency department visits, lowering overall end costs on behalf of patients and health care systems ⁵. A recent retrospective cohort study assessing individuals with lower back pain further confirmed that patients who underwent physiotherapy early on after their visit to the emergency department were less likely to undergo lumbar surgery or advanced imaging procedures, had two times lower medical costs, and were less likely to be administered opioids ⁶. This was corroborated by research finding that physical therapy assessments in the emergency department expedited the selection of appropriate patient-tailored interventions, thereby preventing the occurrence of adverse events following discharge ⁷. Consistently, an international study identified that early physiotherapy for emergency department patients with nontraumatic neck or back pain was linked to reduced disability and pain as compared to patients with an outpatient referral for physical therapy ⁸. In contrast to these studies, however, not all studies yielded statistically significant results in support of such findings. A 2015 randomized clinical trial found that, among adults with recent-onset lower back pain, early physical therapy, while improving disability, resulted in only modest gains, without achieving clinically important differences ⁹.

Overall, early physical therapy intervention is particularly important in light of a saturated and costly health care system. Increasingly established as a first point of care, it allows for the non-pharmacological recovery and sustained well-being of patients. Importantly however, its rapid implementation is key to maximizing its benefits, thereby reducing the unnecessary use of medical resources, minimizing opioid use, and lowering health care costs as effectively as possible.

References 

1. Kim, H. S., Strickland, K. J., Mullen, K. A. & Lebec, M. T. Physical therapy in the emergency department: A new opportunity for collaborative care. American Journal of Emergency Medicine (2018). doi:10.1016/j.ajem.2018.05.053 

2. Polnaszek, B. et al. Omission of Physical Therapy Recommendations for High-Risk Patients Transitioning From the Hospital to Subacute Care Facilities. Arch. Phys. Med. Rehabil. (2015). doi:10.1016/j.apmr.2015.07.013 

3. Pugh, A. et al. Dedicated emergency department physical therapy is associated with reduced imaging, opioid administration, and length of stay: A prospective observational study. PLoS One (2020). doi:10.1371/journal.pone.0231476 

4. Sakamoto, J. T., Ward, H. B., Vissoci, J. R. N. & Eucker, S. A. Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta-analysis. Academic Emergency Medicine (2018). doi:10.1111/acem.13411 

5. Frogner, B. K., Harwood, K., Andrilla, C. H. A., Schwartz, M. & Pines, J. M. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health Serv. Res. (2018). doi:10.1111/1475-6773.12984 

6. Magel, J., Kim, J., Fritz, J. M. & Freburger, J. K. Time between an emergency department visit and initiation of physical therapist intervention: Health care utilization and costs. Phys. Ther. (2020). doi:10.1093/ptj/pzaa100 

7. Stapleton, Z. M., Bohra, M. & Florence, N. Pelvic ring fractures: Role of physical therapy in the emergency department. Journal of Orthopaedic and Sports Physical Therapy (2019). doi:10.2519/jospt.2019.9093 

8. Sohil, P., Hao, P. Y. & Mark, L. Potential impact of early physiotherapy in the emergency department for non-traumatic neck and back pain. World J. Emerg. Med. (2017). doi:10.5847/wjem.j.1920-8642.2017.02.005 

9. Fritz, J. M. et al. Early physical therapy vs usual care in patients with recent-onset low back pain: A randomized clinical trial. JAMA – J. Am. Med. Assoc. (2015). doi:10.1001/jama.2015.11648