Inequities in physical therapy receipt of US service members and Veterans with low back pain
Abstract: Objective: To investigate inequities in time-to physical therapy for patients with low back pain. Design: Retrospective observational study utilizing data from the Department of Defense and Veterans Health Administration clinical and administrative data repositories derived from medical records, claims, and enrollment data. Setting: Military Health System, Veterans Health System, and civilian healthcare facilities. Participants: Active duty service members, veterans and retirees seeking healthcare for low back pain between January 2017 and December 2020, with no low back pain diagnoses for at least 1 year prior (N =1,252,959). Interventions: Not Applicable. Main Outcome Measure(s): Time-to-outpatient physical therapy evaluation within 13 weeks of low back pain diagnosis. Results: Approximately 9.4% of included patients received an outpatient physical therapy evaluation from a physical therapist within 13 weeks of diagnosis. In a piecewise exponential additive model, many covariates were time-varying such that the probability of physical therapy receipt varied throughout the 13-week period. Black, Latinx, and American Indian and Alaskan Native patients had lower probabilities of physical therapy receipt relative to white patients from 1 week to 3-6 weeks after index diagnosis. At 5 and 7 weeks, Black and Latinx patients, respectively, were more likely to receive physical therapy than white patients, which continued till the end of the observation period. Patients assigned female relative to patients assigned male had a higher probability of initiating physical therapy across the entire observation window, as did active duty service members, relative to retired service members and veterans. Conclusions: Inequities in the timing and receipt of physical therapy exist in the US Military Health System and Veterans Health Administration by race and ethnicity, assigned sex, and beneficiary group. Standardizing referral and practice patterns, improving accessibility of physical therapy services and encouraging health seeking behavior may help alleviate the inequities in initiating physical therapy.