Protocol Enabling Earlier Physical Therapy Access Indicates Signs of Success

A protocol that gives patients with back pain quicker access to physical therapy and other treatment is reportedly resulting in better outcomes and lower healthcare costs and utilization.

The rapid access protocol (RAP), developed by a team of physicians, physical therapists, and a hospital administrator, enables patients who typically have a 4-to-6 week wait time to see a PM&R spine specialist to begin immediate (within 72 hours) treatment from a physical therapist while they are awaiting their appointment with the spine specialist.

More specifically, according to a media release from the Association of Academic Physiatrists (AAP), the protocol allows patients whose insurance covers physical therapy without a physician referral to undergo screening with a physical therapist and begin treatment as quickly as possible.

During the initial screening, the physical therapist looks for any red flags that will need the spine specialist’s immediate attention. These include fevers, chills, unintentional weight loss, progressive neurologic symptoms, history of trauma to the back, or pain so severe they are unable to tolerate physical therapy. Barring any of these red flags, the patient will begin physical therapy immediately.

“Physical therapy is important because we know that maintaining a normal lifestyle (ie, continuing to work), staying active, and early participation in an exercise program, is extremely valuable in the management of low back pain,” says Michael Campian, DO, Physical Medicine and Rehabilitation resident at the University of Utah, and part of the team who developed the protocol, in the release.

“We initiated this study to improve the care and satisfaction of people living with low back pain while attempting to reduce healthcare utilization and costs associated with its management,” adds Campian, an investigator on the study, presented recently during the AAP’s Annual Meeting.

The team initiated the RAP a little over 1 year ago. Since then, the team has enrolled 93 participants to examine the RAP’s success.

According to the release, on average, these patients self-reported a greater improvement in physical function (eg, ability to walk, sustain physical activity, etc) compared to those not enrolled in the RAP. Additionally, the patients enrolled in the RAP required fewer x-rays than patients not enrolled (23.8% versus 65.6%). They also required fewer MRIs (3.6% versus 21.%) and injections (4.8% versus 19%).

“Through RAP, patients can start addressing their low back pain immediately, which will hopefully allow them to avoid inactivity and prevent loss of work—which has been demonstrated to negatively affect improvement of back pain—ultimately improving or resolving their back pain,” explains Campain, regarding the protocol’s initial success, in the release.

“This means they won’t have to wait and see a physician whom routinely refers to physical therapy as a first line treatment in most of these cases.”

The team notes in the release that speeding the course of treatment and getting people functioning better earlier has potential to reduce healthcare costs.

“Initially we set off to evaluate the success of rapid access to physical therapy in regards to improvement of low back pain and patient satisfaction, but we noted less frequent utilization of radiographs, MRIs, and injections in these patients—leading us to believe this protocol has the ability to reduce healthcare costs,” Campain explains. “The next step would be to take a closer look at the reduction of healthcare cost with RAP, which is a significantly more complicated metric to evaluate.”