Here is another recent journal article from 2017 that also concludes "early PT offers no benefit":
http://www.thespinejournalonline.com/article/S1529-9430(16)31013-0/abstract
This is directly from the Spine surgeons own medical journal
They have shown that early PT offers zero benefit in terms of decreased cost down the road for subsequent spine care.
Also, the study is done by plenty of "efficiency" internal medicine docs in there as well with a PT.
If you actually read the study you'll see that the first p value is greater than .45.....that's horrifyingly poor and cause for almost immediate dismissal yet you've drawn a broad conclusion from this.
As for the other values in the study, PT RVUs being higher for the early PT group is obvious.....it's because they are being billed for physical therapy services originally. If a group of patients receives spine procedure as a first line then their RVUs from there will be billed at a higher frequency obviously.....and subsequently have more spine RVUs. As for extra imaging, that would be due to physicians ordering imaging following physical therapy tx not alleviating the patient complaints.
That could be a money grab for them or it may be to rule out other pathology....but it is actually out of therapist control since legal ordering is only present in one state. In fact, most imaging is ordered by an ortho, EP, PCP or midlevel contact point (many times never even followed up with or read by the initial biller if primary care) and makes its way onto therapist emr so they can see where decreased joint space in a shoulder might be from mild OA and can change closed chain exercises accordingly.....to not exacerbate symptoms of bone on bone). So the imaging comment is actually irrelevant as "physical therapist waste" since therapists don't generate revenue from it.
Also, the patient population is only over 65......
.....but you've drawn a sweeping generalization over the entire therapy industry here unless you were only referencing low back pain for the demographic 65 and up for spine orthopaedics. Read out of context from the article, "early PT offers no benefit" makes it seem as if it pertains to the entire field.
The conclusion of the article is actually fine in referencing the p values and three statements....but when actually analyzing the data, critiquing the p values, and reading through what "increased imaging" as well as "RVU generation" is.....this piece isn't really impressive and value would only really be placed in using it as a marketing technique for people who don't know how to evaluate literature.....or you just leave things as is and keep them as patient preference without stratify ing one practice pattern.
You just commented in a new thread by the way on an article with Chou and Deyo offering spinal manip as a possible Ortho solution for "back ache" which actually does work acutely if the pain is elicited from the facet joints, although it will return if posture is not addressed.......yet on here referenced a 99 article trying to steer argument.
Your article posting and literature analysis with associated conclusions, quite frankly.....are embarrassing for an attending in practice for a while. I hope you aren't associated with a residency program or mentorship in any way.
