Objectives: To investigate physiotherapy utilisation before lumbar spine surgery under a worker’s compensation claim in Australia.
Study design: Retrospective cohort study.
Methods: Using data from the NSW State Insurance Regulatory Authority, we audited physiotherapy billing codes used before surgery for patients who received lumbar spine surgery from 2010-2018. We summarised, separately for fusion and decompression, the time from initiation of physiotherapy to surgery, number of physiotherapy sessions patients received before surgery, total cost of physiotherapy before surgery, and time from injury date to initiation of physiotherapy. All analyses were descriptive.
Results: We included 3,070 patients (800 had fusion; 2,270 decompression). Mean age (standard deviation, SD) was similar between those who received fusion and decompression [42.9 (10.4) vs. 41.9 (11.6)]. Compared to patients who had fusion, those who had decompression were more likely to not have any physiotherapy before surgery (28.4% vs. 15.4%), received physiotherapy for a shorter duration before surgery [median (interquartile range, IQR): 5 (3 to 11) vs. 15 (4-26) months], were less likely to have physiotherapy for ≥2 years before surgery (5.6% vs. 27.5%), had fewer physiotherapy sessions before surgery [mean (SD): 16 (21) vs. 28 (35) sessions], were less likely to have >50 physiotherapy sessions before surgery (6.8% vs. 18.1%), and had lower total physiotherapy-related costs [mean (IQR): $1,265 ($0-1,808) vs. $2,357 ($453-2,947)]. Time from injury date to first physiotherapy session was similar between patients who had fusion and decompression [median (IQR): 23 (9-66) vs.19 (7-53) days].
Conclusions: There is variation in physiotherapy utilization before lumbar spine surgery for patients funded by NSW Workers’ Compensation. Some patients do not appear to receive an adequate trial of physiotherapy before surgery, particularly before decompression surgery. Others receive a large amount of physiotherapy before surgery, particularly before fusion.