A successful, cost-effective low back pain triage system: a pilot study

Area of Science:

• Orthopedics
• Physical Therapy
• Health Services Research

Background:

• Effective triage is crucial for quality low back pain (LBP) care, preventing unnecessary investigations and interventions.
• Current LBP management often lacks standardized guidelines, leading to suboptimal patient pathways.
• Physician discretion in initial LBP assessment can result in increased healthcare utilization and costs.

Purpose of the Study:

• To compare functional outcomes of LBP patients managed via a clinical presentation-based triage system versus standard clinical discretion.
• To evaluate the impact of a classification-based triage system on healthcare utilization and costs for LBP patients.

Main Methods:

• A prospective study involving 47 physical therapists classifying LBP patients into "Patterns of Pain" based on history and physical exam.
• 260 LBP patients were managed using this classification system, excluding those with red flag symptoms.
• Outcomes (imaging, opioid use, treatment duration, visits, unplanned care, surgery, cost) were compared to a propensity-matched control group (n=256) and a historic cohort (n=111).

Main Results:

• The triage group showed significantly lower rates of spinal imaging (24.5% vs 42.2%) and opioid use (4.6% vs 13.3%) compared to controls.
• Fewer treatment visits (2,046 vs 1,528) and reduced unplanned care (1.9% vs 12.8%) were observed in the study group.
• The classification system led to significant reductions in spine surgery rates (15.4% vs 26.2%) and episode costs ($1453 vs $2334).

Conclusions:

• A well-defined, clinically-based triage system for low back pain is effective in optimizing patient care pathways.
• This system demonstrably reduces unnecessary diagnostic imaging, opioid prescriptions, and healthcare expenditures.
• Implementing such a triage strategy can lead to more efficient and cost-effective management of low back pain.