Spinal fusion surgery use among adults with low back pain enrolled in a digital musculoskeletal program: an observational study

• Published in: BMC musculoskeletal disorders Vol. 25; no. 1; pp. 520 - 8
• Main Authors: Yadav, Sandhya, Gold, Laura S., Zaidi, Qasim Hassan, Hwang, Raymond, Lu, Louie, Wang, Grace
• Format: Journal Article
• Language: English
• Published: London BioMed Central 05.07.2024; BioMed Central Ltd; BMC
• Subjects: Adult; Age groups; Back pain; Back surgery; Backache; Care and treatment; Codes; Comorbidity; Confounding (Statistics); Demographics; Diagnosis related groups; Digital MSK; DRGs; Epidemiology; Female; Health care; Hospital costs; Humans; Internal Medicine; Low back pain; Low Back Pain - diagnosis; Low Back Pain - epidemiology; Low Back Pain - surgery; Lumbar fusion; Male; Medical care; Medical claims; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Methods; Middle Aged; Observational studies; Orthopedics; Personal health; Physical therapy; Physical Therapy Modalities - statistics & numerical data; Physical Therapy Modalities - trends; Physiological aspects; Propensity Score; Rehabilitation; Retrospective Studies; Rheumatology; Spinal fusion; Spinal Fusion - adverse effects; Spinal Fusion - statistics & numerical data; Spinal Fusion - trends; Sports Medicine; Statistics; Surgery; Technology application; Therapeutics, Physiological; Treatment Outcome; Utilization; United States; United States > US; Digital MSK; Lumbar fusion; Medical claims; Low back pain; Spinal fusion
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-024-07573-0

Objectives To compare 12-month spinal fusion surgery rates in the setting of low back pain among digital musculoskeletal (MSK) program participants versus a comparison cohort who only received usual care. Study Design Retrospective cohort study with propensity score matched comparison cohort using commercial medical claims data representing over 100 million commercially insured lives. Methods All study subjects experienced low back pain between January 2020 and December 2021. Digital MSK participants enrolled in the digital MSK low back program between January 2020 and December 2021. Non-participants had low back pain related physical therapy (PT) between January 2020 and December 2021. Digital MSK participants were matched to non-participants with similar demographics, comorbidities and baseline MSK-related medical care use. Spinal fusion surgery rates at 12 months post participation were compared. Results Compared to non-participants, digital MSK participants had lower rates of spinal fusion surgery in the post-period (0.7% versus 1.6%; p  < 0.001). Additionally, in the augmented inverse probability weighting (AIPW) model, digital MSK participants were found to have decreased odds of undergoing spinal fusion surgery (adjusted odds ratio: 0.64, 95% CI: 0.51–0.81). Conclusions This study provides evidence that participation in a digital MSK program is associated with a lower rate of spinal fusion surgery. Key messages • There is limited research comparing spinal fusion surgery rates in digital musculoskeletal (MSK) program participants versus those receiving usual care for low back pain. • This study shows that participation in a digital MSK program was associated with 56% reduction in spinal fusion surgery rates. • These findings highlight the potential of digital MSK programs to reduce spinal fusion surgeries, offering a new direction for reshaping clinical practice in low back pain management.