Back-on-Track Studying Early Quality Care

Physical therapists have an important role as initial contact providers for individuals with
musculoskeletal disorders. Health care expenditures are on the rise each year in the U.S. and
a large proportion is due to musculoskeletal disorders. Despite the rise in spending, there
has not been an improvement in outcomes for individuals with musculoskeletal disorders.
Furthermore, increased medical spending and utilization could expose patients to iatrogenic
harm. Comparative effectiveness studies of different portals of entry would help to determine
the most effective pathways for individuals with musculoskeletal disorders to seek care. The
purpose of this study is to determine whether patients with musculoskeletal injuries do
better by seeing a primary care provider first versus seeing a physical therapist first.
Subjects will be enrolled from two sites (Temple University, Philadelphia, PA and Brooke Army
Medical Center, San Antonio, TX). Patient self-reported outcomes measures will be collected
at baseline and 6 weeks. At 6 months, healthcare utilization will be assessed. The
investigators plan to enroll a target sample size of 75 subjects per site (150 total).
Descriptive statistics will be computed to characterize the 2 treatment groups with ANCOVA
being used to assess differences between treatment groups at 6 weeks, adjusting for baseline
values, evaluating the assumption of parallel slopes. The investigators will further
investigate sources of systematic differences in response to treatment using methods such as
generalized estimating equations and linear mixed effects models. This research will be the
first multi-site study to compare effectiveness of these two pathways for individuals with
musculoskeletal pain in the U.S. With a growing older adult population, the percentage of
individuals who have musculoskeletal pain in the U.S. will only increase over time. This
research study is timely and could meet the need for identifying the most effective pathway
for individuals with musculoskeletal pain to seek care.

Inclusion Criteria:

1. A patient at Temple University Employee Health, OR, Brooke Army Medical Center.

2. Able to speak English sufficiently to understand informed consent

3. A patient with a musculoskeletal condition as their primary complaint

4. Greater than 18 years old

5. Within 90 days (3 months) of either initial musculoskeletal onset or repeat acute
recurrence of a previous episode

Exclusion Criteria:

1. Patients have already sought care from provider for their presenting condition for
this current episode

2. Patients have an insurance plan that requires them to see an outside provider prior to
seeing the study providers