Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type


Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

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.


College of Health Care Sciences - Physical Therapy Department

First Advisor

Shari Rone-Adams

Second Advisor

Bill Boissonnault

Third Advisor

Matt Briggs

Publication Date / Copyright Date



Nova Southeastern University


Dysfunction and disability arising from low back pain (LBP) affects more people than any other condition globally, and results in changes to the quality of life for many individuals. The financial burden of managing low back pain is among the highest both in the United States and globally. Clinical practice guidelines (CPGs) provide recommendations on patient management strategies and have the potential to simultaneously improve patient outcomes and lower health care costs. Limited evidence exists on the impact of CPG implementation on downstream medical costs that are incurred after physical therapist care. A retrospective observational study was conducted that examined the financial impact of implementing a LBP CPG in outpatient physical therapist practice, along with patient outcomes. Retrospective billing and clinical data from 270 patients with LBP who were treated at multiple sites within one health system were analyzed from September 2017 to March 2018, six months before implementation activities began and from June 2018 to December 2018, six months into the implementation of the LBP CPG. Costs for direct physical therapy and downstream medical charges, physical therapy utilization, and patient reported outcomes for the pre-implementation group were compared with the post-implementation group. The results of the study shed light on the positive impact that the implementation of the LBP CPG in outpatient physical therapist practice had on lowering downstream costs.


Physical Therapy


Clinical practice guideline, Evidence-based practice, Implementation, Low back pain, Physical therapy