Presented at the 2013 AAPM Annual Meeting « Back

Guideline Concordance and Recovery for Veterans with Acute Nonspecific LBP

Patricia L. Sinnott, PT PhD MPH, patricia.sinnott@va.gov¹, Anjali S. Upadhyay, MS², Todd H. Wagner, PhD³, (1) VA Palo Alto Health Care System, Menlo Park, California, (2) Department of Veterans Affairs, Menlo Park, California, (3) VA Palo Alto and Stanford University, Menlo Park, California

Background and Purpose: To assess the influence of the ACP/APS/VA/DOD Clinical Practice Guideline for the Management of LBP in Primary Care on patient recovery. Data and Variable Creation Cases with non-specific low back pain (LBP) were identified by ICD codes in VA FY2002-2009 administrative data. Incident encounters were identified and cases with incident events in FY2007 were analyzed. Patient recovery was defined by absence of care for LBP in the 91-365th day following the incident encounter. Patients who did not use any VHA services after the 91st day were excluded. Guideline concordance in the first 30 days of care was defined by CPT codes, and characterized by type of service. Analyses Logistic regression was used to model the probability of recovery. Demographic characteristics, and indicators for medical and mental health conditions, incident severity, previous year health care costs, VA station fixed effects and predictors for guideline concordant care were included. Results: The cohort included 53,288 Veterans with LBP. Patients who received physician evaluation and management services were slightly more likely to recover than those who did not (OR 1.04, 95% CI1.00-1.08); those who received chiropractic manipulation were less likely to recover (OR 0.74, 95%CI 0.60-0.92) and those who received selected active physical medicine treatments were most likely to recover (OR 1.29, 95%CI1.20-1.39). Conclusion: Observational analysis of administrative data suggests that patients who receive active physical medicine treatment are more likely to recover from an acute episode of nonspecific LBP, than those who receive physician evaluation and management or chiropractic manipulation.

Funding: Funding for this study was provided by the VA Health Services Research and Development Service (HSR&D IIR 09-062) and was approved by the Stanford IRB and the VA Palo Alto Health Care Research and Development program.