Predictors of Physical, Chiropractic, and Acupuncture Therapy Utilization in the Three Months Following Newly Diagnosed Low Back Pain.

Abstract

Retrospective cohort study. To assess the relative utilization and predictors of physical therapy (PT), chiropractic therapy (CT), and acupuncture therapy (AT) within 90 days of low back pain (LBP) diagnosis. LBP is the most common musculoskeletal problem globally. Following diagnosis, patients often seek treatments including PT, CT, and AT, however, their relative use and drivers of therapeutic selection remain poorly characterized. Adults diagnosed with LBP who utilized PT, CT, or AT within 90 days were identified from the PearlDiver M161 database. Exclusion criteria included: therapy utilization before diagnosis and those presenting for trauma, neoplasm, or infection. Patients utilizing each therapy type were characterized based on clinical and nonclinical factors and compared by univariable analyses and multivariable logistic regression. Of 10,046,167 LBP patients, no therapy/other was noted for 9,560,636 (94.78%), PT for 413,554 (4.10%), CT for 103,444 (1.03%), and AT for 10,026 (0.10%).Independent predictors of CT utilization, relative to PT, were lower age [per decade increase: odds ratio (OR): 0.986], male sex (OR: 1.046), lower Elixhauser Comorbidity Index (ECI, per 1-point increase: OR: 0.882), lower mean family income: (OR: 0.999), lower unemployment: (OR: 0.888), region (relative to South: Northeast OR: 0.773, Midwest OR: 1.265), and insurance (relative to commercial: Medicaid OR: 0.489, Medicare OR: 0.896; P <0.001 for all).Independent predictors of AT utilization, relative to PT, were lower ECI (OR: 0.960), higher mean family income (OR: 1.0000160), region (West OR: 2.214, Northeast OR: 1.390, Midwest OR: 1.293), and insurance (Medicaid OR: 0.372, Medicare OR: 0.510; P <0.001 for all). PT was more frequently utilized than both CT and AT within 90 days of LBP diagnosis. However, clinical and nonclinical factors proved to be significant predictors for patients who utilized CT and AT versus PT. Understanding these drivers helps characterize therapy utilization patterns at a national level, an area previously not well defined. Level III.