The timing of physical therapy (PT) services and its relationship with later function and pain is not clear, particularly in older adults. The objective of this study was to compare clinical outcomes of patients receiving early or later PT services to those not receiving PT among older adults presenting to primary care for a new visit for back pain. The early PT group had better functional status with an adjusted mean RMDQ 1.1 points less than the no early PT group (95% CI: -2.2, -0.1), and less back pain, -0.5 (95% CI: -0.9, -0.1) at 12 months. There was no difference between early PT groups at 3 and 6 months. The odds of a 30% improvement in function or pain were not different between these matched groups at 12 months, but the early PT group had increased odds of a 50% improvement in function at 12 months (OR=1.58, 95% CI: 1.04, 2.40). There was no difference between later groups at 12 months. Greater dose of PT use within the early PT group was related to preferable functional status (p= 0.01).
This study found that among older adults presenting to their primary care providers for a new episode of back pain, early referral to PT resulted in no or minimal differences in pain, function, or health-related quality at 3, 6, or 12 months when compared to a matched group that did not receive early PT. Secondary analysis reveal that patients initiating early PT may be somewhat more likely to experience 50% improvement in function at 12 months.