December 12, 2023

Comorbidities and Recovery After Physical Therapy for Low Back Pain

The Workers’ Compensation Research Institute (WCRI) published Comorbidities and Recovery After Physical Therapy for Low Back Pain, a new report that examines the prevalence of self-reported comorbidities, assesses the association between self-reported comorbidities and functional improvements, and identifies other important predictors of physical therapy (PT) outcomes.

The report utilizes data from 68,850 workers who were injured on the job and received physical therapy for low back pain, who had their first and last PT visit over the 2017-2021 period.

These data included information on patient-reported functional outcomes, patient-level socio-demographics, self-reported comorbidities, and other characteristics.

Common comorbidities reported among these patients included:

  • Hypertension across 28% of patients
  • Arthritis across 21% of patients
  • Sleep dysfunction across 17% of patients
  • Depression across 16% of patients
  • Anxiety or panic disorders across 16% of patients
  • Lung conditions across 11% of patients
  • Diabetes across 10% of patients
  • Gastrointestinal disease across 10% of patients
  • Severe obesity across 9% of patients

Approximately one in four workers reported having three or more comorbidities, but the report found that mental health comorbidities had a stronger association than physical health comorbidities with functional outcomes related to the delivery of PT services.

Comorbidities such as sleep dysfunction, severe obesity, and kidney disease were independently associated with smaller functional improvements following physical therapy. When measuring functional status (FS) scores across patients during intake and after discharge, larger improvements were seen in patients with physical comorbidities when compared to mental health comorbidities.

Additionally, the report found that FS score changes decreased as patient age increased, even after accounting for differences in patient characteristics across age groups.

While the report notes that routine screening, assessment, and treatment of these disorders may be challenging to implement in the workers’ comp system at large, it should be noted that physical therapists often have the most face-to-face time with patients, giving them insight into behavioral or mental health concerns that are impacting recovery.

The WCRI report also noted that the timeliness of the provision of PT services for low back pain was strongly related to improved functional outcomes following PT, even more strongly related than comorbidities.

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