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Bypassing the doctor.

Byline: Randi Bjornstad The Register-Guard

Finding ways to control the rising cost of health care has been a high priority locally and nationally for years, and a statewide group called the Oregon Health Leadership Council is doing its part by trying out some novel ways to address the problem.

One is the "Low Back Pain Pilot Project," which is nearly halfway through a two-year experiment - supported by most of the major health insurance companies in the state - to allow people who experience low back pain to go immediately and directly to physical therapists without visiting a primary care physician first for a checkup or referral.

"Physical therapy right away for lower back pain has been shown to significantly reduce cost and improve patient condition," Eugene physical therapist Judy Cirullo said. "It also minimizes costs for repeated physician visits and imaging such as MRIs. The idea is to show that this condition can be helped more quickly and at lower cost than traditionally has been the case."

Upwards of 90 percent of the population experiences low back pain at some point in life, "and if it's not treated promptly and then self-managed, it may return and will cost much more money for the patient and the insurance company," said Cirullo, who served on the committee that designed the program.

Although the Low Back Pain Pilot Project has been under way for nearly a year, it hasn't been advertised widely, "and the council would like to see many more people become aware so they can participate in this project and benefit from its results," Cirullo said.

A brochure produced by the Oregon Health Leadership Council summarizes the program this way: "The goal is to reduce loss of work time, improve the functional status and satisfaction of the patient, and reduce downstream medical costs."

The quicker a person with acute low back pain gets to a physical therapist, the sooner the root cause of the pain can be determined and a regiment of exercise, education and self-treatment can begin.

"Studies show that the more active patients are about seeking treatment for acute back pain, the sooner they will feel better and the more likely that their condition will not become chronic," Cirullo said. "If back pain interferes with what you do on a daily basis, it is something that should be evaluated and treated in the shortest possible period of time."

Part of the problem with treating low back pain is the difficulty many people have in recognizing it. The pain can be sharp or achy, constant or intermittent. It can be felt side-to-side during movement or only when sitting, lying in bed or doing other specific activities. It can come and go. Pain that occurs in the waist, upper waist, upper buttocks and hips is considered low back pain.

Many times the first bout of low back pain resolves itself rather quickly, so the patient doesn't seek medical attention. "In that case, the person often doesn't know what to do to improve back strength so it doesn't happen again, so it recurs and becomes even worse," Cirullo said.

To participate in the program, a patient's episode of back pain has to have been going on for less than 90 days.

When a physical therapist examines a patient for low back pain, "if the symptoms are not affected by position or mechanical movement, that is a red flag, and the therapist may refer the person to a regular physician for further evaluation," Cirullo said.

That's why, under the Low Back Pain Pilot Project, people who call a physical therapist about back pain are asked specific questions to rule out more serious underlying health issues before being accepted for an appointment. Back pain that results from on-the-job injuries, falls or motor vehicle accidents does not qualify for the program. Nor is it available to people who receive their health care through Medicare, which is not a participating insurance carrier.

Those who qualify for the project must be offered an appointment that falls within two business days of the initial call. Each participant will receive a maximum of four visits with the physical therapist. No "modalities" such as ultrasound or other imaging are part of the pilot program, Cirullo said.

At the first appointment, which takes about 45 minutes, the patient will be asked to fill out an entry questionnaire. The rest of the visits, about 30 minutes each, include mobilization and manipulation of the back, education about exercise and self-care to help the immediate problem, and learning how to maintain good back health even after the pain is gone. At the end of the series of visits, the patient completes an exit questionnaire about the experience.

HOW TO PARTICIPATE IN THE LOW BACK PAIM PILOT PROJECT

About the program: www.orhealthleadershipcouncil.org/evidence-based-best-practices/low-back-pain

Area participating physical therapists:

Eugene Physical Therapy, 1410 Oak St.; 541-345-2064

Eugene Physical Therapy, 54 Oakway Center; 541-687-7005

Oregon Spine & Physical Therapy, 560 Country Club Road, Suite B; 541-683-5139

PT Solutions, 2675 Willamette St.; 541-343-8889

Slocum Orthopedics, 55 Coburg Road; 541-485-8111
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Title Annotation:Disease
Publication:The Register-Guard (Eugene, OR)
Date:Oct 22, 2012
Words:841
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