How Timing is Key in the World of PT

By Brian Peers

Vice President, Clinical Services and Provider Management

MedRisk  

There’s a saying that goes, “To be early is to be on time, to be on time is to be too late.” You may see this as a hyperbole in many situations, but in the case of physical therapy, we might find that there is wisdom in the famous expression.

There’s no debate on physical therapy’s benefit to recovery for various musculoskeletal conditions. From neck, shoulder, back, hip, to knee injuries, PT has helped lower the number of cases requiring costly surgery and dangerous prescription drugs. It also brings down overall costs significantly. However, many of these benefits are still critically linked to one important thing — timing.

So, if it’s clearly crucial, how can we maximize the value of PT through timing?  

Starting and educating early 

PT is understood to be the first-line treatment for musculoskeletal injuries before considering addictive opioid prescriptions and invasive procedures. But researchers have also long agreed that there are significant benefits to starting physical therapy early – that is, within 14 days post-injury. According to a 2020 Workers Compensation Research Institute study, for workers with low back pain, early initiation of PT (as defined by WCRI) is associated with lower utilization, lower costs and a 42% decrease in the duration of temporary disability versus late post-injury PT. Moreover, decades of research have also shown that patients achieve better outcomes when they are treated in the acute stage (less than 6 weeks) compared to the chronic stage (more than 3 months). 

To drive more positive patient outcomes, early access to PT and patient education must also go hand in hand. Studies show that an initial consultation with a PT provider may reduce overall healthcare utilization (e.g., opioid use) for patients seeking care. In this initial consultation, the PT can identify possible barriers to recovery — including psychosocial barriers — and can recommend the best course of action to mitigate them. 

Because patients spend a great deal of time with their PT more than anyone else in the process, establishing a positive relationship between the patient and their therapist is also key. It’s one thing for PTs to deliver their advice but another if the patient truly receives and understands the intended message. PTs can use strategies like motivational interviewing, shared decision-making, and the prescription of simple, personalized exercises to make certain that patients hear and understand both their diagnosis and treatment plan.

Taking it a step further with early manual therapy 

To further reap these benefits, practitioners are also seen shifting focus to one very specific type: manual therapy (MT). 

A 2020 systematic review of randomized controlled trials updated a 2013 review exploring the value of MT among other interventions over the past several years. The 2020 review concludes by strongly recommending MT be integrated as an additional therapy. This supports earlier study results, which observed that patients who received only exercise (without MT) were 8 times more likely to experience a worsening disability compared to patients receiving exercise and MT treatment. 

An initial study in 2021 from WCRI on MT for LBP claims also showed that the time temporary disability per claim was 22% shorter and the average indemnity payment per claim was 28% lower when workers received early MT compared with those receiving it later; a positive step towards more effective WC outcomes. 

The utilization of early MT has also shown a positive impact on three key factors that impact case duration that happen to be traditionally difficult to tackle — patient age, surgical status, and case complexity. With early MT, some data show that patients between the age of 51 and 60 are discharged seven days sooner and those 61+, nine days sooner when they’ve received early MT. Following surgery, patients receiving early MT also require less treatment over a longer period of time than those who receive MT late in the episode. Furthermore, the use of early MT has proven to lead to fewer visits over a shorter duration for complex cases involving more than one ailment. 

Timing is key for maximized PT benefits

In general, the growing use of PT has proven to be valuable as treatment for musculoskeletal injuries. But in order to truly maximize its value, organizations must support and encourage early intervention. Rather than waiting until a case gets serious and pain becomes chronic, utilizing PT early in the game allows for lower costs, better use of medical resources, and more optimal results in the most effective way possible.

Author Bio

Brian Peers, DPT, MBA 

Vice President, Clinical Services and Provider Management

MedRisk 

2701 Renaissance Blvd.

King of Prussia, PA 19406

800-225-9675 x 1011

BPeers@Medrisknet.com 

Brian Peers is a licensed physical therapist serving as MedRisk’s Vice President of Clinical Services and Provider Management. He is responsible for overseeing and ensuring the quality of MedRisk’s centralized telerehabilitation services, as well as MedRisk’s platinum grade clinical review and peer-to peer provider coaching program. He is board certified as an orthopedic clinical specialist and is recognized as an expert in rehabilitation of the injured worker. Prior to joining MedRisk, Dr. Peers was the owner and operator of an interdisciplinary rehab practice and has held faculty appointments at multiple physical therapy education programs. He has also served as an injury prevention consultant for multiple large corporations and the United States Department of Defense. He holds Bachelor of Science and Master of Physical Therapy degrees from St. Francis University in Loretto, Pennsylvania, an MBA from Louisiana State University in Baton Rouge, Louisiana and a Doctorate in Physical Therapy from the University of St. Augustine, in St. Augustine, Florida. 

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