Expectations,Outcomes,and Medical Costs in Patients with Low Back Pain Referred to Physical Therapy

To describe treatment expectations among patients referred to physical therapy (PT) for low back pain (LBP) and to examine the relationship among expectations, outcomes, and medical care costs, 111 patients referred to PT for LBP within a managed care environment were studied in a prospective cohort study. Both χ ² and Student's t tests, as well as one-way analyses of variance, were used to assess bivariate differences in expectations, outcomes, and medical costs. A backward-stepping multivariate regression algorithm was used to assess the role of expectations, controlling for patient characteristics on (1) the change in patient-reported improvement between admission and discharge, and (2) annual medical expenditures. Patients' treatment expectations, pain levels, and functional levels were measured at the initial PT visit. Pain and functional status were also measured at PT discharge. Medical care expenditures were compiled for the 12 months following PT referral. Patients with the highest level of expectations reported the greatest level of improvement at PT discharge and had the lowest 12-month average medical care expenditures. Conversely, patients with the lowest level of expectations reported the lowest level of improvement and had the highest 12-month average medical expenditures. LBP patients' expectations about treatment were associated with outcomes, and additionally predictive of medical care expenditures. We found that among LBP patients referred to PT, patients with the highest expectation level at baseline reported the greatest improvement and the lowest medical care expenditures.