Poster Presentation Sydney Spinal Symposium 2022

Physiotherapy utilization, costs and return to work status following lumbar spine surgery: a retrospective analysis of workers compensation claims in Australia (#122)

Joshua R Zadro 1 , Adriane M Lewin 2 , Priti Kharel 1 , Justine Naylor 2 , Christopher G Maher 1 , Ian A Harris 1 3 , Giovanni Ferreira 1
  1. Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Camperdown, NEW SOUTH WALES, Australia
  2. Whitlam Orthopaedic Research Centre, University of New South Wales, Sydney, NSW, Australia
  3. Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia, Sydney , NSW, Australia

Background: No study has explored physiotherapy utilization following lumbar spine surgery in a workers’ compensation setting, or in Australia.

Aims: Describe physiotherapy utilization and costs, and return to work status in patients following lumbar spine surgery under a NSW workers’ compensation claim in Australia.

Design: Retrospective cohort study.

Methods: Using data from the New South Wales (NSW) State Insurance Regulatory Authority (Australia), we audited physiotherapy billing codes for patients who received lumbar spine surgery from 2010-2017. We summarised, by fusion vs. decompression, the number of physiotherapy sessions patients received to 12 months post-operatively, total cost of physiotherapy and time to initiation of physiotherapy. We assessed the association between number of physiotherapy sessions or physiotherapy utilization at 12 months and return to work at 12 months. All data were analysed descriptively. 

Results: We included 3,524 patients (1,220 had fusion, 2,304 decompression). On average, patients received 22 (standard deviation (SD)=22, range=0 to 160) physiotherapy sessions in the 12 months post-operatively (mean cost=$1,768, interquartile range (IQR)=$405 to $2,557); 24% were receiving physiotherapy at 12 months. Most patients had 9-24 (31%) or 25-50 sessions (25%); 11% had >50 sessions, whereas 11% had no physiotherapy. Patients who had fusion (vs. decompression) had more physiotherapy (25 vs. 20 sessions) and incurred higher means physiotherapy costs ($2,016 vs. $1,637). Median time to initiate physiotherapy increased from 2010-2017. Mean number of physiotherapy sessions was not associated with return to work status.

Limitations: We did not have data on the type of physiotherapy treatment patients received.

Conclusions: There is variation in physiotherapy utilization and costs following lumbar spine surgery for patients funded by NSW Workers’ Compensation. Since effective rehabilitation programs following lumbar spine surgery typically involve 8-24 physiotherapy sessions, overtreatment may be an issue for some patients in our sample. Future research is needed to understand the drivers of physiotherapy practice patterns in this setting.