The Influence of Active, Passive, and Manual Therapy Interventions for Low Back Pain on Opioid Prescription and Health Care Utilization

Shawn Farrokhi*, Laura Bechard, Sara Gorczynski, Charity Patterson, Joseph Kakyomya, Brad D. Hendershot, Rachel Condon, L. T.C.Matthew Perkins, Daniel I. Rhon, Anthony Delitto, Michael Schneider, Christopher L. Dearth

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective. The aim of this study was to explore associations between the utilization of active, passive, and manual therapy interventions for low back pain (LBP) with 1-year escalation-of-care events, including opioid prescriptions, spinal injections, specialty care visits, and hospitalizations. Methods. This was a retrospective cohort study of 4827 patients identified via the Military Health System Data Repository who received physical therapist care for LBP in 4 outpatient clinics between January 1, 2015 and January 1, 2018. One-year escalation-of-care events were evaluated based on type of physical therapist interventions (ie, active, passive, or manual therapy) received using adjusted odds ratios. Results. Most patients (89.9%) received active interventions. Patients with 10% higher proportion of visits that included at least 1 passive intervention had a 3% to 6% higher likelihood of 1-year escalation-of-care events. Similarly, with 10% higher proportion of passive to active interventions used during the course of care, there was a 5% to 11% higher likelihood of 1-year escalation-of-care events. When compared to patients who received active interventions only, the likelihood of incurring 1-year escalation-of-care events was 50% to 220% higher for those who received mechanical traction and 2 or more different passive interventions, but lower by 50% for patients who received manual therapy. Conclusion. Greater use of passive interventions for LBP was associated with elevated odds of 1-year escalation-of-care events. In addition, the use of specific passive interventions such as mechanical traction in conjunction with active interventions resulted in suboptimal escalation-of-care events, while the use of manual therapy was associated with more favorable downstream health care outcomes.

Original languageEnglish
Article numberpzad173
JournalPhysical Therapy
Issue number3
StatePublished - 1 Mar 2024
Externally publishedYes


  • Electric Stimulation Therapy
  • Exercise
  • Hot/Cold Pack
  • Low Back Pain
  • Manual Therapy
  • Needle Therapy
  • Traction


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