Health Sciences Program Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Health Science

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

Department

College of Health Care Sciences – Health Science Department

First Advisor

Moya Alfonso

Date of original Performance / Presentation

January 2025

Publication Date / Copyright Date

1-1-2025

Abstract

Low back pain (LBP) is one of the costliest health care conditions in the United States (US) as well as the one of the leading diagnoses associated with opioid prescriptions in the country. Nonpharmacological pain treatments (NPTs) are strategies used to manage LBP symptoms without the use of medication or invasive procedures. While NPTs, including physical therapy, chiropractic, and acupuncture, are recommended by LBP clinical practice guidelines, it is unclear how often they are used among individuals living in rural parts of the country where they may experience challenges, such as low provider availability and decreased access to transportation. It is also unclear whether NPTs have the same effect on downstream health care utilization among rural individuals as they do among nonrural individuals among whom most studies have been conducted in this area. Therefore, this investigator used payer claims data to examine differences in NPT utilization among rural and nonrural adults (18-65 years) with a recent onset of LBP as well as the influence of NPT utilization on downstream health care utilization and costs among both groups. The results of this study are suggestive that rural individuals use NPTs (overall) at similar rates to those living in nonrural areas (48.8% vs. 47.5%, respectively), but are more likely to use chiropractic (+8.11%, 95% CI [7.78, 8.45]) and less likely to use physical therapy (-5.38%. 95% [-5.62, -5.14]) than those living in nonrural areas. Overall NPT use was associated with decreased probabilities of downstream opioid use and emergency department (ED) visits among both rural and nonrural individuals. However, there was substantial variation in the effects of specific NPTs on downstream care utilization. Overall, NPT use was also associated with reduced LBP-related health care spending among rural ($-379.12, 95% CI: [-506.11, -252.13]) and nonrural ($-100.36, 95% CI [-147.12, -53.61]) individuals. There was variation in the influence of specific NPT services on 12-month costs with chiropractic driving overall health care spending reductions.

Disciplines

Medicine and Health Sciences

Keywords

disability; low back pain; nonpharmacological pain treatment; nonrural; rural

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