Association between early nonpharmacological management and follow-up for low back pain in the veterans health administration

BACKGROUND: Low back pain (LBP) is a common reason individuals seek healthcare. Nonpharmacologic management (NPM) is often recommended as a primary intervention, and earlier use of NPM for LBP shows positive clinical outcomes. Our purpose was to evaluate how timing of engagement in NPM for LBP affec...

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Autores principales: Coleman, Brian C., Lisi, Anthony J., Abel, Erica A., Runels, Tessa, Goulet, Joseph L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10333712/
https://www.ncbi.nlm.nih.gov/pubmed/37440983
http://dx.doi.org/10.1016/j.xnsj.2023.100233
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author Coleman, Brian C.
Lisi, Anthony J.
Abel, Erica A.
Runels, Tessa
Goulet, Joseph L.
author_facet Coleman, Brian C.
Lisi, Anthony J.
Abel, Erica A.
Runels, Tessa
Goulet, Joseph L.
author_sort Coleman, Brian C.
collection PubMed
description BACKGROUND: Low back pain (LBP) is a common reason individuals seek healthcare. Nonpharmacologic management (NPM) is often recommended as a primary intervention, and earlier use of NPM for LBP shows positive clinical outcomes. Our purpose was to evaluate how timing of engagement in NPM for LBP affects downstream LBP visits during the first year. METHODS: This study was a secondary analysis of an observational cohort study of national electronic health record data. Patients entering the Musculoskeletal Diagnosis/Complementary and Integrative Health Cohort with LBP from October 1, 2016 to September 30, 2017 were included. Exclusive patient groups were defined by engagement in NPM within 30 days of entry (“very early NPM”), between 31 and 90 days (“early NPM”), or not within the first 90 days (“no NPM”). The outcome was time, in days, to the final LBP follow-up after 90 days and within the first year. Cox proportional hazards regression was used to model time to final follow up, controlling for additional demographic and clinical covariables. RESULTS: The study population included 44,175 patients, with 16.7% engaging in very early NPM and 13.1% in early NPM. Patients with very early NPM (5.2 visits, SD=4.5) or early NPM (5.7 visits, SD=4.6) had a higher mean number of LBP visits within the first year than those not receiving NPM in the first 90 days (3.2 visits, SD = 2.5). The very early NPM (HR=1.50, 95% CI: 1.46–1.54; median=48 days, IQR=97) and early NPM (HR=1.27, 95% CI: 1.23–1.30; median=88 days, IQR=92) had a significantly shorter time to final follow-up than the no NPM group (median=109 days, IQR=150). CONCLUSIONS: Veterans Health Administration patients receiving NPM for LBP within the first 90 days after initially seeking care demonstrate a significantly faster time to final follow-up visit within the first year compared to those who do not.
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spelling pubmed-103337122023-07-12 Association between early nonpharmacological management and follow-up for low back pain in the veterans health administration Coleman, Brian C. Lisi, Anthony J. Abel, Erica A. Runels, Tessa Goulet, Joseph L. N Am Spine Soc J Clinical Studies BACKGROUND: Low back pain (LBP) is a common reason individuals seek healthcare. Nonpharmacologic management (NPM) is often recommended as a primary intervention, and earlier use of NPM for LBP shows positive clinical outcomes. Our purpose was to evaluate how timing of engagement in NPM for LBP affects downstream LBP visits during the first year. METHODS: This study was a secondary analysis of an observational cohort study of national electronic health record data. Patients entering the Musculoskeletal Diagnosis/Complementary and Integrative Health Cohort with LBP from October 1, 2016 to September 30, 2017 were included. Exclusive patient groups were defined by engagement in NPM within 30 days of entry (“very early NPM”), between 31 and 90 days (“early NPM”), or not within the first 90 days (“no NPM”). The outcome was time, in days, to the final LBP follow-up after 90 days and within the first year. Cox proportional hazards regression was used to model time to final follow up, controlling for additional demographic and clinical covariables. RESULTS: The study population included 44,175 patients, with 16.7% engaging in very early NPM and 13.1% in early NPM. Patients with very early NPM (5.2 visits, SD=4.5) or early NPM (5.7 visits, SD=4.6) had a higher mean number of LBP visits within the first year than those not receiving NPM in the first 90 days (3.2 visits, SD = 2.5). The very early NPM (HR=1.50, 95% CI: 1.46–1.54; median=48 days, IQR=97) and early NPM (HR=1.27, 95% CI: 1.23–1.30; median=88 days, IQR=92) had a significantly shorter time to final follow-up than the no NPM group (median=109 days, IQR=150). CONCLUSIONS: Veterans Health Administration patients receiving NPM for LBP within the first 90 days after initially seeking care demonstrate a significantly faster time to final follow-up visit within the first year compared to those who do not. Elsevier 2023-06-01 /pmc/articles/PMC10333712/ /pubmed/37440983 http://dx.doi.org/10.1016/j.xnsj.2023.100233 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Studies
Coleman, Brian C.
Lisi, Anthony J.
Abel, Erica A.
Runels, Tessa
Goulet, Joseph L.
Association between early nonpharmacological management and follow-up for low back pain in the veterans health administration
title Association between early nonpharmacological management and follow-up for low back pain in the veterans health administration
title_full Association between early nonpharmacological management and follow-up for low back pain in the veterans health administration
title_fullStr Association between early nonpharmacological management and follow-up for low back pain in the veterans health administration
title_full_unstemmed Association between early nonpharmacological management and follow-up for low back pain in the veterans health administration
title_short Association between early nonpharmacological management and follow-up for low back pain in the veterans health administration
title_sort association between early nonpharmacological management and follow-up for low back pain in the veterans health administration
topic Clinical Studies
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10333712/
https://www.ncbi.nlm.nih.gov/pubmed/37440983
http://dx.doi.org/10.1016/j.xnsj.2023.100233
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